Provider Demographics
NPI:1083958276
Name:VANN, MICHAEL T (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:VANN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-2127
Mailing Address - Country:US
Mailing Address - Phone:347-244-1097
Mailing Address - Fax:
Practice Address - Street 1:327 FULTON ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-2127
Practice Address - Country:US
Practice Address - Phone:347-244-1097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237790-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse