Provider Demographics
NPI:1285446641
Name:VITALO, LLC
Entity type:Organization
Organization Name:VITALO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZURCHER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:816-517-8336
Mailing Address - Street 1:401 N MAIN ST STE 14
Mailing Address - Street 2:
Mailing Address - City:GRAVOIS MILLS
Mailing Address - State:MO
Mailing Address - Zip Code:65037-6253
Mailing Address - Country:US
Mailing Address - Phone:816-517-8336
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:GRAVOIS MILLS
Practice Address - State:MO
Practice Address - Zip Code:65037-6253
Practice Address - Country:US
Practice Address - Phone:816-517-8336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty