Provider Demographics
NPI:1467682898
Name:VERGARA, BLANCA QUEBEDO (RN)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:QUEBEDO
Last Name:VERGARA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 CEDAR LAKE RD S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1458
Mailing Address - Country:US
Mailing Address - Phone:952-544-6223
Mailing Address - Fax:952-544-6271
Practice Address - Street 1:5811 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1458
Practice Address - Country:US
Practice Address - Phone:952-544-6223
Practice Address - Fax:952-544-6271
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1765386163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse