Provider Demographics
NPI:1033796495
Name:VAUGHN, MICHELLE PATRICE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:PATRICE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:PATRICE
Other - Last Name:ROYBAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:590 BRITANNIA DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7006
Mailing Address - Country:US
Mailing Address - Phone:510-691-3818
Mailing Address - Fax:
Practice Address - Street 1:2500 ALHAMBRA AVE
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-3156
Practice Address - Country:US
Practice Address - Phone:925-370-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA685050164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse