Provider Demographics
NPI:1811385461
Name:VARGA, LANCE MICHAEL (APRN)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:MICHAEL
Last Name:VARGA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 HIGHWAY 109
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63025-1243
Mailing Address - Country:US
Mailing Address - Phone:314-267-9926
Mailing Address - Fax:
Practice Address - Street 1:4110 HIGHWAY 109
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63025-1243
Practice Address - Country:US
Practice Address - Phone:314-267-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309619363L00000X
IAH142277363L00000X
MDAC001545363L00000X
VA0024172583363L00000X
MO2014042985363L00000X
MO2018006271363LF0000X
IAA154211363LF0000X
NYF345730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner