Provider Demographics
NPI:1699346817
Name:VITAGLIANO, WENDY LYNN
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LYNN
Last Name:VITAGLIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:LYNN
Other - Last Name:REITER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9570 CORDOVA RD SW
Mailing Address - Street 2:
Mailing Address - City:BOWERSTON
Mailing Address - State:OH
Mailing Address - Zip Code:44695-9671
Mailing Address - Country:US
Mailing Address - Phone:740-269-3134
Mailing Address - Fax:
Practice Address - Street 1:2600 TUSCARAWAS ST W STE 160
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4696
Practice Address - Country:US
Practice Address - Phone:330-454-9126
Practice Address - Fax:330-454-9470
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner