Provider Demographics
NPI:1508986258
Name:VARGHESE, MINI JOY (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MINI
Middle Name:JOY
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:MINI
Other - Middle Name:JOY
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4919 DAISEY CREEK TER
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1140
Mailing Address - Country:US
Mailing Address - Phone:301-931-8866
Mailing Address - Fax:301-931-8866
Practice Address - Street 1:4919 DAISEY CREEK TER
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1140
Practice Address - Country:US
Practice Address - Phone:301-931-8866
Practice Address - Fax:301-931-8866
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered