Basic Information
| Provider Information | |||||||||
| NPI: | 1891059234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIETTI | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5325 FARAON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 645063488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162716406 | ||||||||
| FaxNumber: | 8162716789 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 FARAON ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162716406 | ||||||||
| FaxNumber: | 8162716789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2012021649 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 2016014758 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 2012021649 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.