Provider Demographics
NPI:1104487313
Name:MUNOZ VARGAS, ANDREA PAULINA (LPN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:PAULINA
Last Name:MUNOZ VARGAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12715 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1027
Mailing Address - Country:US
Mailing Address - Phone:509-232-5766
Mailing Address - Fax:509-321-5472
Practice Address - Street 1:1320 MONITOR ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3536
Practice Address - Country:US
Practice Address - Phone:509-300-1221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60883082164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2077844Medicaid