Provider Demographics
NPI:1528098639
Name:VARDMAN, MARGUERITE MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:MARIE
Last Name:VARDMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARGUERITE
Other - Middle Name:MARIE
Other - Last Name:TERLEMEZIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 740015
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-0015
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:625 S MARIETTA PKWY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-2748
Practice Address - Country:US
Practice Address - Phone:470-377-7228
Practice Address - Fax:470-467-7583
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 14568363LA2200X
MA132550363LA2200X
GA076035363LA2200X
NY304370363LF0000X
SCF4379363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS06042Medicare UPIN
GA50BBKXFMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER