Doctor Name: | BRENDA KAY MATHEWS-VITELLO |
NPI Number: | 1003084237 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CRNP |
License Number: | R154292 |
Business Practice Address: | 116 Defense Hwy Suite 400 Annapolis, MD - 214017027 |
Business Phone Number: | 4108979841 |
Business Fax Number: | 4108979852 |
Mailing Address: | 116 Defense Hwy, Suite 400 ANNAPOLIS |
State: | MD |
Postal Code: | 214017027 |
Phone Number: | 4108979841 |
Fax Number: | 4108979852 |
NPI Enumeration Date: | 02/11/2008 |
NPI Last Update Date: | 06/27/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R154292 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |