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General NPI Number Information
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NPI Number | 1205721685
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Entity Type | Individual
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Provider Name | MARY THERESE VITTERA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 801 BRAXTON PL
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City | MADISON
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State | WI
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Zip | 53715-1415
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Country | US
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Telephone | 608-260-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 BOWEN CT APT 309
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City | MADISON
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State | WI
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Zip | 53715-1362
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Country | US
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Telephone | 612-221-1801
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 10844002
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License Number State | MN
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