Individual
ELI D VANDITTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1200 INTREPID AVE, PHILADELPHIA, PA 19112-1229
(208) 818-6229
Mailing address
852 E SHADOW WOOD LN, COEUR D ALENE, ID 83815-5111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
53259
ID
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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