Provider Demographics
NPI:1376776823
Name:VARGAS, JEAN M (RN, CRRN, CCM, BSN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RN, CRRN, CCM, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:17500 N. TERRITORIAL RD.
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-0071
Mailing Address - Country:US
Mailing Address - Phone:734-475-9572
Mailing Address - Fax:
Practice Address - Street 1:9670 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9464
Practice Address - Country:US
Practice Address - Phone:734-944-2561
Practice Address - Fax:734-944-2561
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704112449163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1005829660Medicaid