Provider Demographics
NPI:1457302705
Name:VARGO, DIANE MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:VARGO
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30033 CLEMENS RD
Mailing Address - Street 2:CLEVELAND CLINIC
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1021
Mailing Address - Country:US
Mailing Address - Phone:440-899-5555
Mailing Address - Fax:440-808-5737
Practice Address - Street 1:30033 CLEMENS RD
Practice Address - Street 2:CLEVELAND CLINIC
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1021
Practice Address - Country:US
Practice Address - Phone:440-899-5555
Practice Address - Fax:440-808-5737
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08317363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner