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General NPI Number Information
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NPI Number | 1417647066
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Entity Type | Organization
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Legal Business Name | VITAL FAMILY HEALTHCARE LLC.
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 09/29/2023
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Provider Practice Location Address
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Address Line | 1004 LOGAN AVE
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City | BELVIDERE
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State | IL
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Zip | 61008
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Country | US
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Telephone | 815-482-6365
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Fax |
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Provider Business Mailing Address
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Address Line | 1004 LOGAN AVE
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City | BELVIDERE
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State | IL
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Zip | 61008
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Country | US
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Telephone | 815-482-6365
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JACLYN NEWHART
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Credential |
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Telephone | 708-653-3496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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