Healthcare Provider Details

I. General information

NPI: 1992405781
Provider Name (Legal Business Name): JANELLE MARIE VARGAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 SAND STREET
MILAN NM
87021
US

IV. Provider business mailing address

948 ELM DR
GRANTS NM
87020-3008
US

V. Phone/Fax

Practice location:
  • Phone: 505-285-2729
  • Fax:
Mailing address:
  • Phone: 505-285-4580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number59692
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: