Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 2012013478 | MO |
N | 208000000X | Pediatrician | 2009014225 | MO |
NPI | 1063641223 |
---|---|
Provider Name | Dr. Josie Vitale |
First Address | Saint Louis, MO 63127-1665 |
Second Address | Saint Louis, MO 63127-1665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 22/07/2016 |