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General NPI Number Information
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NPI Number | 1265197362
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTHCARE PLLC
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Dates
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Enumeration Date | 11/03/2021
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Last Update Date | 01/15/2023
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Provider Practice Location Address
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Address Line | 4222 ANGIER AVE
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City | DURHAM
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State | NC
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Zip | 27703-5941
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Country | US
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Telephone | 919-667-5287
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21365
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City | DURHAM
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State | NC
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Zip | 27703-1365
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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 | CEO
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Name | LOTOYA TATUM
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Credential | RN
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Telephone | 919-667-5287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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