Provider Demographics
NPI:1114740990
Name:VITALI, DANIELA K
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:K
Last Name:VITALI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 MARKET AVE SW APT 258
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-4086
Mailing Address - Country:US
Mailing Address - Phone:616-826-7260
Mailing Address - Fax:
Practice Address - Street 1:234 MARKET AVE SW APT 258
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4086
Practice Address - Country:US
Practice Address - Phone:616-826-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5202-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered