Provider Demographics
NPI:1154156560
Name:VARGAS, VERONICA ELDORA (LPN)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ELDORA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:ELDORA
Other - Last Name:PASCUAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-1107
Mailing Address - Country:US
Mailing Address - Phone:360-916-8040
Mailing Address - Fax:
Practice Address - Street 1:1700 HUDSON ST STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2931
Practice Address - Country:US
Practice Address - Phone:360-583-3394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60775774164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse