| NPI | 1053031559 |
|---|---|
| Former Legal Business Name | VITALE PSYCHIATRIC |
| Entity Type | Organization |
| Authorized Contact | SHANDRA TYUS Owner 224-627-4229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2024-09-09 |