Provider Demographics
NPI:1093595779
Name:NORDICK-VARGAS, JEAN ELIZABETH
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ELIZABETH
Last Name:NORDICK-VARGAS
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 1:271 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-9408
Mailing Address - Country:US
Mailing Address - Phone:919-449-4945
Mailing Address - Fax:
Practice Address - Street 1:271 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-9408
Practice Address - Country:US
Practice Address - Phone:919-449-4945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician