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General NPI Number Information
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NPI Number | 1902775984
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Entity Type | Organization
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Legal Business Name | VITALITY FAMILY MEDICAL & WELLNESS PLLC
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Dates
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Enumeration Date | 10/30/2025
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 232 MAIN ST NW STE 203
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2186
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Country | US
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Telephone | 815-954-0136
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Fax |
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Provider Business Mailing Address
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Address Line | 232 MAIN ST NW STE 203
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2186
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AO
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Name | KAREN N SMARTT
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Credential |
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Telephone | 717-504-3090
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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 |
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License Number State |
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