Provider Demographics
NPI:1275933657
Name:VAUGHAN, JESSICA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:VAUGHAN
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 1:538 S HAMMOND RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-4250
Mailing Address - Country:US
Mailing Address - Phone:315-324-6032
Mailing Address - Fax:
Practice Address - Street 1:538 S HAMMOND RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:NY
Practice Address - Zip Code:13646-4250
Practice Address - Country:US
Practice Address - Phone:315-324-6032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286013164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse