Provider Demographics
NPI:1912709908
Name:VARGAS, ATHENA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:ATHENA
Middle Name:MARIE
Last Name:VARGAS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:MARIE
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5038 S 86TH PKWY APT 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-5500
Mailing Address - Country:US
Mailing Address - Phone:515-570-1761
Mailing Address - Fax:
Practice Address - Street 1:5038 S 86TH PKWY APT 8
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-5500
Practice Address - Country:US
Practice Address - Phone:515-570-1761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE21566164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse