Tavia Marie Vital, RN, CDE

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

041390337 Issued in IL

Practice address

2560 24TH St
Suite 102
Rock Island, IL 61201-5357

Phone

(309) 788-0014

Fax

(309) 793-3092

NPI assigned

Aug 5, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1508145756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2560 24TH ST",
            "address_2": "SUITE 102",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015357",
            "telephone_number": "309-788-0014",
            "fax_number": "309-793-3092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2560 24TH ST",
            "address_2": "SUITE 102",
            "city": "ROCK ISLAND",
            "state": "IL",
            "postal_code": "612015357",
            "telephone_number": "309-788-0014",
            "fax_number": "309-793-3092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITAL",
        "first_name": "TAVIA",
        "middle_name": "MARIE",
        "credential": "RN, CDE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-05",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "IL",
            "license": "041390337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandee Nicole Velez, SOCIAL WORKER
• Jannette Vermeire
• Victor J Barney MD PC
• Leslie Villalpando, MA, BS, MHP
• Anna Marie Vinzant, DOT
• Theodore Eric Vogel-Wilson
• Heidi Vorac
• Sandra J Voss, LSW, LMSW
• Jack G Vukov, MD
• Danielle Jillian Waddle, LMSW

• Diabetes Educator Registered Nurse in Rock Island, IL
• Providers in Rock Island, IL by specialty
• Diabetes Educator Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.