Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A167460 | CA |
N | 207X00000X | Orthopaedic Surgeon | MD61154921 | WA |
N | 207X00000X | Orthopaedic Surgeon | MT206268 | PA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 61154921 | WA |
NPI | 1114332327 |
---|---|
Provider Name | Nicholas John Vaudreuil |
First Address | Everett, WA 98201-4261 |
Second Address | Everett, WA 98201-4261 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 29/07/2021 |