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General NPI Number Information
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NPI Number | 1154891869
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Entity Type | Individual
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Provider Name | MRS. KATRINA VITALE
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Gender | Female
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Dates
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Enumeration Date | 11/26/2018
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 270 HIGHWAY 35
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City | RED BANK
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State | NJ
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Zip | 07701-5920
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Country | US
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Telephone | 732-842-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 386 MIDDLEWOOD RD
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-1328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 343795
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ00960600
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License Number State | NJ
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