Individual
SABRINA PROVVIDENZA VITALE-D'ANGELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
709 W MAIN ST, MANCHESTER, IA 52057-1526
(563) 927-7457
(563) 927-7457
Mailing address
PO BOX 359, MANCHESTER, IA 52057-0359
(563) 927-7457
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
D175517
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5208192
CSA
IA
01
—
D175517
STATE LICENSE
IA
01
—
MV8194843
DEA
IA
Enumeration date
03/18/2021
Last updated
11/26/2024
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