Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704327050NSA190BM | MI |
N | 363LA2100X | Nurse Practitioner - Acute Care | 4704327050NSA190BM | MI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4704327050NSA190BM | MI |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704327050NSA190BM | MI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 4704327050NSA190BM | MI |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704327050NSA190BM | MI |
N | 363LX0106X | Nurse Practitioner - Occupational Health | 4704327050NSA190BM | MI |
NPI | 1346805769 |
---|---|
Provider Name | Mr. Von Deneb Vitto |
First Address | Livonia, MI 48150-1216 |
Second Address | Livonia, MI 48150-1216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2019 |
Last Update Date | 06/01/2020 |