CHANGE CENTER FOR VITALITY NPI 1720390362

NPI Information

CHANGE CENTER FOR VITALITY is a family nurse practitioner in Little Rock, AR. CHANGE CENTER FOR VITALITY NPI is 1720390362. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

400 W CAPITOL AVE
STE 100D
LITTLE ROCK, AR
ZIP 72201-436
Phone: (501) 324-2649

The provider's authorized official is Debra Velez .
The authorized official title is President and has the following contact phone number (501) 324-8649.

The CLIA number assigned to this NPI record is 04D1079751 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/12/2010 and was last updated on 7/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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