Provider Demographics
NPI:1144052564
Name:VARGHESE, SUJA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUJA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KOMATKE HEALTH CENTER
Mailing Address - Street 2:17487 S. HEALTH CARE DR.
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:602-528-7940
Mailing Address - Fax:520-550-6292
Practice Address - Street 1:17487 S HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8500
Practice Address - Country:US
Practice Address - Phone:602-528-1200
Practice Address - Fax:520-550-6292
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ310176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily