Provider Demographics
NPI:1992405781
Name:VARGAS, JANELLE MARIE (RN)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 ELM DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-3008
Mailing Address - Country:US
Mailing Address - Phone:505-285-4580
Mailing Address - Fax:
Practice Address - Street 1:404 SAND STREET
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:NM
Practice Address - Zip Code:87021
Practice Address - Country:US
Practice Address - Phone:505-285-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM59692163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse