Provider Demographics
NPI:1629746219
Name:VARGAS, ADELLA MARGARET (RN)
Entity Type:Individual
Prefix:
First Name:ADELLA
Middle Name:MARGARET
Last Name:VARGAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W. AMAROSA AVE.
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401
Mailing Address - Country:US
Mailing Address - Phone:575-461-3910
Mailing Address - Fax:
Practice Address - Street 1:1701 S 9TH ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-3281
Practice Address - Country:US
Practice Address - Phone:575-461-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR60176163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool