Provider Demographics
NPI:1396030383
Name:VARGHESE, SWAPNA MATHEW
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:MATHEW
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SWAPNA
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:13 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5306
Mailing Address - Country:US
Mailing Address - Phone:713-906-0816
Mailing Address - Fax:
Practice Address - Street 1:13 FRENCH ST
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5306
Practice Address - Country:US
Practice Address - Phone:713-906-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX734389363LF0000X
CT005507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily