Healthcare Provider Details

I. General information

NPI: 1619261385
Provider Name (Legal Business Name): JENCY VARUGHESE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N GALLOWAY AVE
MESQUITE TX
75149-2433
US

IV. Provider business mailing address

1203 WILDFLOWER LN
MESQUITE TX
75149-2631
US

V. Phone/Fax

Practice location:
  • Phone: 214-320-7000
  • Fax:
Mailing address:
  • Phone: 469-879-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number231741
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: