Healthcare Provider Details

I. General information

NPI: 1952140584
Provider Name (Legal Business Name): LORI ANN MEJIA VARGAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 E BROADWAY AVE STE 1
MOSES LAKE WA
98837-5934
US

IV. Provider business mailing address

821 E BROADWAY AVE STE 1
MOSES LAKE WA
98837-5934
US

V. Phone/Fax

Practice location:
  • Phone: 509-350-4785
  • Fax:
Mailing address:
  • Phone: 509-350-4785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberRN60468118
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: