Provider Demographics
NPI:1548874928
Name:VITARELLI, KRISTY MARIE (RN)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:VITARELLI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1466 CLINTONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2644
Mailing Address - Country:US
Mailing Address - Phone:718-640-7797
Mailing Address - Fax:
Practice Address - Street 1:1466 CLINTONVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-2644
Practice Address - Country:US
Practice Address - Phone:718-640-7797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY719580163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse