Individual
DERRICK LEE VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
209 DIVISION AVE S APT 107, GRAND RAPIDS, MI 49503-4547
(313) 974-9107
Mailing address
922 OGDEN AVE SE, GRAND RAPIDS, MI 49506-3561
(313) 974-9107
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/21/2021
Last updated
08/21/2021
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