Provider Demographics
NPI:1912884834
Name:VITAL NP - INTEGRATIVE MEDICINE & WELLNESS SERVICES, LLC
Entity type:Organization
Organization Name:VITAL NP - INTEGRATIVE MEDICINE & WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:443-207-0733
Mailing Address - Street 1:6113 REGENT PARK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1805
Mailing Address - Country:US
Mailing Address - Phone:443-207-0733
Mailing Address - Fax:
Practice Address - Street 1:11 NEWBURG AVE STE 3
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5172
Practice Address - Country:US
Practice Address - Phone:443-207-0733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care