Doctor Name: | MELISSA VAUGHAN |
NPI Number: | 1598040149 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP011674 |
Business Practice Address: | 4102 Pinion Dr U S A F Academy, CO - 808402502 |
Business Phone Number: | 7193335951 |
Business Fax Number: | 7193334566 |
Mailing Address: | 307 S Front St, 1st Floor HARRISBURG |
State: | PA |
Postal Code: | 171041621 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/14/2011 |
NPI Last Update Date: | 07/02/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | SP011674 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |