Provider Demographics
NPI:1871810184
Name:VARGHESE, USHA (LPN)
Entity type:Individual
Prefix:
First Name:USHA
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NEW HAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2229
Mailing Address - Country:US
Mailing Address - Phone:845-215-5568
Mailing Address - Fax:
Practice Address - Street 1:719 W NYACK RD STE 27
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2241
Practice Address - Country:US
Practice Address - Phone:845-358-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238180-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse