Individual
TAVIA MARIE VITAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDE
Contact information
Practice address
2560 24TH ST, SUITE 102, ROCK ISLAND, IL 61201-5357
(309) 788-0014
(309) 793-3092
Mailing address
2560 24TH ST, SUITE 102, ROCK ISLAND, IL 61201-5357
(309) 788-0014
(309) 793-3092
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
041390337
IL
Other
Enumeration date
08/05/2011
Last updated
08/05/2011
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