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General NPI Number Information
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NPI Number | 1831639954
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Entity Type | Organization
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Legal Business Name | VITALCARE MEDICAL, LLC
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 34 UNION AVE SUITE 1
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City | IRVINGTON
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State | NJ
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Zip | 07111-3219
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Country | US
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Telephone | 973-985-8382
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8210
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City | GLEN RIDGE
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State | NJ
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Zip | 07028-8210
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Country | US
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Telephone | 973-985-8382
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. TAMICA SHEILA LAWSON
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Credential | APN
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Telephone | 973-985-8382
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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 | 26NJ00486800
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License Number State | NJ
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