Provider Demographics
NPI:1750785069
Name:VAUGHAN, MONICA EUGENIE (LPN)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:EUGENIE
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 1:229 S 7TH AVE
Mailing Address - Street 2:APT 1S
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-3859
Mailing Address - Country:US
Mailing Address - Phone:914-409-2525
Mailing Address - Fax:
Practice Address - Street 1:229 S 7TH AVE
Practice Address - Street 2:APT 1S
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-3859
Practice Address - Country:US
Practice Address - Phone:914-409-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295586-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse