Provider Demographics
NPI:1093526121
Name:VANCE, KAITLYN DEE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:DEE
Last Name:VANCE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:DEE
Other - Last Name:VENUTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3305 E FRY BLVD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2990
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3305 E FRY BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2990
Practice Address - Country:US
Practice Address - Phone:520-515-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260983163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse