Individual
BERONDA VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
100 POWELL DR STE 1, DUNDEE, MI 48131-8645
(517) 299-1481
Mailing address
301 OHIO RIVER DR, ADRIAN, MI 49221-3762
(517) 306-7059
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703105359
MI
164W00000X
Licensed Practical Nurse
PN138136
OH
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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