MEDICARE: CRYSTAL BROOKE VITERNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1912719204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL BROOKE VITERNA

Provider Business Mailing Address
First Line	:	2304 N EASTWOOD ST LOT 14
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-1907
Country	:	US
Telephone Number	:	402-316-6824
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 N EASTWOOD ST LOT 14
Second Line	:
City	:	NORFOLK
State	:	NE
Zip	:	68701-1907
Country	:	US
Telephone Number	:	402-316-6824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	09/11/2025

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Directions to “ CRYSTAL BROOKE VITERNA ” Practice Location

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