Healthcare Provider Details

I. General information

NPI: 1033700364
Provider Name (Legal Business Name): VITALITY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 2ND AVE E
WESTHOPE ND
58793-4027
US

IV. Provider business mailing address

PO BOX 124
WESTHOPE ND
58793-0124
US

V. Phone/Fax

Practice location:
  • Phone: 701-245-6300
  • Fax: 855-435-5155
Mailing address:
  • Phone: 701-245-6300
  • Fax: 855-435-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANN MARY KVEUM
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 701-263-1435