Provider Demographics
NPI:1346805769
Name:VITTO, VON (DNP, AGNP-C)
Entity type:Individual
Prefix:MR
First Name:VON
Middle Name:
Last Name:VITTO
Suffix:
Gender:M
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 836
Mailing Address - Street 2:
Mailing Address - City:HOUSATONIC
Mailing Address - State:MA
Mailing Address - Zip Code:01236-0836
Mailing Address - Country:US
Mailing Address - Phone:413-274-8298
Mailing Address - Fax:413-287-7649
Practice Address - Street 1:PO BOX 836
Practice Address - Street 2:
Practice Address - City:HOUSATONIC
Practice Address - State:MA
Practice Address - Zip Code:01236-0836
Practice Address - Country:US
Practice Address - Phone:413-274-8298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2340600363L00000X
MI4704327050NSA190BM363L00000X, 363LA2200X, 363LC0200X, 363LG0600X, 363LX0106X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health