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General NPI Number Information
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NPI Number | 1710404892
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Entity Type | Organization
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Legal Business Name | VITALITY WELLNESS INSTITUTE
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 07/25/2018
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Provider Practice Location Address
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Address Line | 214 HIGHWAY 3086
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City | JENKINS
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State | KY
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Zip | 41537
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Country | US
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Telephone | 276-220-2408
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 21833
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 386-313-5287
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Fax |
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Authorized Official
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Title or Position | CREDENTIALIST
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Name | APRIL NAFUS
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Credential |
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Telephone | 570-901-1957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3006206
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License Number State | KY
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