Healthcare Provider Details

I. General information

NPI: 1083567648
Provider Name (Legal Business Name): VITALIS PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E MAPLE ST STE 110
BELLINGHAM WA
98225-5708
US

IV. Provider business mailing address

1313 E MAPLE ST STE 110
BELLINGHAM WA
98225-5708
US

V. Phone/Fax

Practice location:
  • Phone: 360-685-7173
  • Fax:
Mailing address:
  • Phone: 360-685-7173
  • Fax: 360-253-6365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NAZEER KABIR
Title or Position: MANAGING MEMBER
Credential: ARNP
Phone: 682-408-6472