Provider Demographics
NPI:1508508953
Name:VACHON, LAUREN (AGNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VACHON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 WALLINGFORD DR NW
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9314
Mailing Address - Country:US
Mailing Address - Phone:313-269-5961
Mailing Address - Fax:
Practice Address - Street 1:72 SHELDON AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4234
Practice Address - Country:US
Practice Address - Phone:616-331-9830
Practice Address - Fax:616-331-9831
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1518019223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty