Basic Information
| Provider Information | |||||||||
| NPI: | 1154717619 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VITHALANI | ||||||||
| FirstName: | NICKI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 THIRD ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172427297 | ||||||||
| FaxNumber: | 7172427741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2015 | ||||||||
| LastUpdateDate: | 08/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | 151429 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 390200000X | MT209571 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207QH0002X | MD467593 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.