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General NPI Number Information
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NPI Number | 1346838067
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Entity Type | Individual
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Provider Name | BERONDA VAUGHN LPN
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Gender | Female
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Dates
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Enumeration Date | 01/07/2021
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Last Update Date | 01/07/2021
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Provider Practice Location Address
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Address Line | 100 POWELL DR STE 1
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City | DUNDEE
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State | MI
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Zip | 48131-8645
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Country | US
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Telephone | 517-299-1481
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Fax |
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Provider Business Mailing Address
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Address Line | 301 OHIO RIVER DR
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City | ADRIAN
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State | MI
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Zip | 49221-3762
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Country | US
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Telephone | 517-306-7059
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN138136
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 4703105359
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License Number State | MI
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