Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 200650065NP | OR |
NPI | 1043330343 |
---|---|
Provider Name | Vivian B Vargo |
First Address | Portland, OR 97209-3964 |
Second Address | Gresham, OR 97030-7317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 27/08/2019 |