Provider Demographics
NPI:1588420871
Name:VARGAS GIL, JENNYFER ANDREA
Entity type:Individual
Prefix:
First Name:JENNYFER
Middle Name:ANDREA
Last Name:VARGAS GIL
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 1:2400 BELVIDERE RD RM 1132
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6165
Mailing Address - Country:US
Mailing Address - Phone:847-377-8681
Mailing Address - Fax:
Practice Address - Street 1:2400 BELVIDERE RD RM 1132
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6165
Practice Address - Country:US
Practice Address - Phone:847-377-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator