Basic Information
| Provider Information | |||||||||
| NPI: | 1760617070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGULIC | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5185 PEACHTREE PKWY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300926542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708809696 | ||||||||
| FaxNumber: | 7708401901 | ||||||||
| Practice Location | |||||||||
| Address1: | 5185 PEACHTREE PKWY | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | NORCROSS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300926542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708809696 | ||||||||
| FaxNumber: | 7708401901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2009 | ||||||||
| LastUpdateDate: | 05/17/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WA2000X | RN082798 | GA | Y | Nursing Service Providers | Registered Nurse | Administrator |
No ID Information.