Provider Demographics
NPI:1801527239
Name:AVILES, DULCE IVETH VARGAS (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:DULCE
Middle Name:IVETH VARGAS
Last Name:AVILES
Suffix:
Gender:
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:DULCE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 RIVER PLACE DR STE 450
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-5402
Mailing Address - Country:US
Mailing Address - Phone:313-835-5990
Mailing Address - Fax:313-835-5920
Practice Address - Street 1:15400 W MCNICHOLS RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3724
Practice Address - Country:US
Practice Address - Phone:313-835-5990
Practice Address - Fax:313-835-5920
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073544363LP0200X
MI4704422777363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics