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General NPI Number Information
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NPI Number | 1205554193
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Entity Type | Organization
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Legal Business Name | VITAL WAYS WELLNESS
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Dates
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Enumeration Date | 08/17/2022
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 834 PIERCE PL
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City | HARTFORD
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State | WI
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Zip | 53027-9282
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Country | US
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Telephone | 262-448-3289
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Fax |
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Provider Business Mailing Address
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Address Line | N92W17420 APPLETON AVE SUITE 103#402
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051
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Country | US
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Telephone | 262-448-3289
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Fax | 262-404-8256
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Authorized Official
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Title or Position | OWNER
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Name | LEILA PINTER
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Credential | NP
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Telephone | 262-448-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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