Provider Demographics
NPI:1871260828
Name:VARGAS, SUJELL M
Entity Type:Individual
Prefix:
First Name:SUJELL
Middle Name:M
Last Name:VARGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1327
Mailing Address - Country:US
Mailing Address - Phone:808-250-1909
Mailing Address - Fax:
Practice Address - Street 1:7456 S STATE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6623
Practice Address - Country:US
Practice Address - Phone:312-626-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily