Provider Demographics
NPI:1932444866
Name:VITALE, MICHELLE E (PA-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:VITALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10 LIBERTY LN
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2772
Mailing Address - Country:US
Mailing Address - Phone:724-552-3358
Mailing Address - Fax:
Practice Address - Street 1:10 LIBERTY LN
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2772
Practice Address - Country:US
Practice Address - Phone:724-552-3358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055876363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical