Provider Demographics
NPI:1538451885
Name:MIRGUET, VICKI
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:
Last Name:MIRGUET
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:FRALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 3RD CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5103
Mailing Address - Country:US
Mailing Address - Phone:573-268-0989
Mailing Address - Fax:
Practice Address - Street 1:307 3RD CT
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5103
Practice Address - Country:US
Practice Address - Phone:573-268-0989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator