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General NPI Number Information
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NPI Number | 1548600547
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Entity Type | Individual
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Provider Name | MARY LAUREL VARGHESE NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/05/2013
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Last Update Date | 11/10/2016
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Provider Practice Location Address
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Address Line | 6 S POINSETT HWY TRAVELERS REST INTERNAL MEDICINE
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City | TRAVELERS REST
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State | SC
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Zip | 29690-1822
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Country | US
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Telephone | 864-834-7834
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Fax | 864-834-7477
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Provider Business Mailing Address
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Address Line | PO BOX 743294
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City | ATLANTA
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State | GA
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Zip | 30374-3294
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Country | US
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Telephone | 864-834-7834
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Fax | 864-834-7477
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 20185
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License Number State | SC
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