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General NPI Number Information
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NPI Number | 1144052564
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Entity Type | Individual
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Provider Name | SUJA VARGHESE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/15/2024
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 17487 S HEALTHCARE DR
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City | LAVEEN
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State | AZ
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Zip | 85339-8500
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Country | US
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Telephone | 602-528-1200
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Fax | 520-550-6292
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Provider Business Mailing Address
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Address Line | KOMATKE HEALTH CENTER 17487 S. HEALTH CARE DR.
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City | LAVEEN
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State | AZ
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Zip | 85339
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Country | US
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Telephone | 602-528-7940
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Fax | 520-550-6292
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 310176
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License Number State | AZ
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