Provider Demographics
NPI:1639507833
Name:VARGAS, MARTHA (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
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 1:27 LUDLOW ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-1963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 LUDLOW ST
Practice Address - Street 2:APT 4B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1963
Practice Address - Country:US
Practice Address - Phone:914-457-0991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY663052163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse