Provider Demographics
NPI:1699276295
Name:VITALE, SABRINA (NP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11386 TIMBERS DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48094-3775
Mailing Address - Country:US
Mailing Address - Phone:586-381-0909
Mailing Address - Fax:
Practice Address - Street 1:11386 TIMBERS DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MI
Practice Address - Zip Code:48094-3775
Practice Address - Country:US
Practice Address - Phone:586-381-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704288337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner