Provider Demographics
NPI:1811289465
Name:VAUGHAN, MARLA (RN BSN IBCLC)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:RN BSN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BALMA LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-9621
Mailing Address - Country:US
Mailing Address - Phone:707-795-3039
Mailing Address - Fax:
Practice Address - Street 1:64 BALMA LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-9621
Practice Address - Country:US
Practice Address - Phone:707-795-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301963163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant