Provider Demographics
NPI:1518027432
Name:VITALE, PATRICIA MICHELINA (RN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MICHELINA
Last Name:VITALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MICHELINA
Other - Middle Name:
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1010 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-534-4212
Mailing Address - Fax:617-534-4221
Practice Address - Street 1:300 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2809
Practice Address - Country:US
Practice Address - Phone:617-534-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA109154163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)