Provider Demographics
NPI:1790909166
Name:VARGAS, LYNN MALLARI (CNA)
Entity Type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MALLARI
Last Name:VARGAS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 GLACIER ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4726
Mailing Address - Country:US
Mailing Address - Phone:907-351-4895
Mailing Address - Fax:907-333-1729
Practice Address - Street 1:2905 GLACIER ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4726
Practice Address - Country:US
Practice Address - Phone:907-351-4895
Practice Address - Fax:907-333-1729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK#000251310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL7982Medicaid