Provider Demographics
NPI:1194231746
Name:VARELA, AMBER LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:VARELA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-5526
Mailing Address - Country:US
Mailing Address - Phone:920-254-3627
Mailing Address - Fax:
Practice Address - Street 1:1213 N WATER ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-3201
Practice Address - Country:US
Practice Address - Phone:920-645-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI322261-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse