Healthcare Provider Details

I. General information

NPI: 1376776823
Provider Name (Legal Business Name): JEAN M. VARGAS RN, CRRN, CCM, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 SHERWOOD DR
SALINE MI
48176-9464
US

IV. Provider business mailing address

PO BOX 71 17500 N. TERRITORIAL RD.
CHELSEA MI
48118-0071
US

V. Phone/Fax

Practice location:
  • Phone: 734-944-2561
  • Fax: 734-944-2561
Mailing address:
  • Phone: 734-475-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704112449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: