Provider Demographics
NPI:1144566928
Name:VAUGHN, GRACIE (LVN)
Entity Type:Individual
Prefix:
First Name:GRACIE
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:GRACIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24229 EL PILAR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3505
Mailing Address - Country:US
Mailing Address - Phone:949-600-0711
Mailing Address - Fax:
Practice Address - Street 1:24229 EL PILAR
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-3505
Practice Address - Country:US
Practice Address - Phone:949-600-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-23
Last Update Date:2012-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN236696164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse