Provider Demographics
NPI:1124734843
Name:VARGAS, LISA CLAIRE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CLAIRE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:WEST FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04992-0342
Mailing Address - Country:US
Mailing Address - Phone:207-418-5044
Mailing Address - Fax:
Practice Address - Street 1:223 TOWN FARM RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-5841
Practice Address - Country:US
Practice Address - Phone:207-418-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN32785163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health