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General NPI Number Information
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NPI Number | 1891499497
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Entity Type | Organization
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Legal Business Name | VITALITY WELLNESS LLC
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 8707 SPRING CYPRESS RD STE E
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City | SPRING
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State | TX
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Zip | 77379-3331
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Country | US
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Telephone | 832-562-3390
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Fax | 832-562-3391
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Provider Business Mailing Address
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Address Line | 8707 SPRING CYPRESS RD STE E
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City | SPRING
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State | TX
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Zip | 77379-3331
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Country | US
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Telephone | 832-562-3390
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Fax | 832-562-3391
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | NICOLE CROSBY
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Credential | NP
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Telephone | 832-562-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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