MEDICARE: MS. DIANA VARGAS WHNP, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	F420615	NY
2	163WM0102X	Maternal Newborn Registered Nurse	342448	NY
3	163WL0100X	Lactation Consultant (Registered Nurse)	142904	NY
4	363L00000X	Nurse Practitioner	F420615	NY

General Provider Information

NPI Number	:	1336462233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA VARGAS WHNP, IBCLC

Provider Business Mailing Address
First Line	:	PO BOX 95000-4145
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-0001
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	2771 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3027
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2010
Last Update Date	:	08/07/2013

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