| NPI | 1649744178 |
|---|---|
| Former Name | MADISON ANN VITELLI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: PA MA060311) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00603200) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-02-21 |