Provider Demographics
NPI:1871797506
Name:VAUGHAN, MARY LYNETTE (LMT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:LYNETTE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S. 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105
Mailing Address - Country:US
Mailing Address - Phone:402-505-8220
Mailing Address - Fax:
Practice Address - Street 1:6160 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68132-1236
Practice Address - Country:US
Practice Address - Phone:402-553-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2149225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist