Provider Demographics
NPI:1114726635
Name:AGING WITH VITALITY- AWV LLC
Entity type:Organization
Organization Name:AGING WITH VITALITY- AWV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:SASHANNA
Authorized Official - Last Name:ARVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP- MSN, BC
Authorized Official - Phone:914-837-1997
Mailing Address - Street 1:19 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-1402
Mailing Address - Country:US
Mailing Address - Phone:914-837-1997
Mailing Address - Fax:
Practice Address - Street 1:19 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-1402
Practice Address - Country:US
Practice Address - Phone:914-837-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty