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General NPI Number Information
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NPI Number | 1528302742
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Entity Type | Individual
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Provider Name | GINA MARIE VITALE-AMOS NP-C
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Gender | Female
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 204 S BELLEVUE AVE
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City | DOVER
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State | OH
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Zip | 44622-9405
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Country | US
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Telephone | 234-801-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 204 S BELLEVUE AVE
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City | DOVER
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State | OH
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Zip | 44622-9405
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Country | US
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Telephone | 234-801-4747
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN278267
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN115701
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | COA-NP14020
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License Number State | OH
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