Provider Demographics
NPI:1255609889
Name:VAUTRIN, JOHN M (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:VAUTRIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-2449
Mailing Address - Country:US
Mailing Address - Phone:315-866-2981
Mailing Address - Fax:
Practice Address - Street 1:311 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-2449
Practice Address - Country:US
Practice Address - Phone:315-866-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-10
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638576163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health