Healthcare Provider Details

I. General information

NPI: 1326960097
Provider Name (Legal Business Name): MICHELLE CLAIRE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11306 DAVENPORT ST
OMAHA NE
68154-2630
US

IV. Provider business mailing address

11306 DAVENPORT ST
OMAHA NE
68154-2630
US

V. Phone/Fax

Practice location:
  • Phone: 402-884-1645
  • Fax: 402-884-1647
Mailing address:
  • Phone: 402-884-1645
  • Fax: 402-884-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: