Provider Demographics
NPI:1053627521
Name:VAUGHN, CHAROLETTE LUDDEKE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CHAROLETTE
Middle Name:LUDDEKE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 PORCH PLACE WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3009
Mailing Address - Country:US
Mailing Address - Phone:251-990-6493
Mailing Address - Fax:
Practice Address - Street 1:400 E LAUREL AVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2620
Practice Address - Country:US
Practice Address - Phone:251-943-6646
Practice Address - Fax:251-943-4486
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-024030163W00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163W00000XNursing Service ProvidersRegistered Nurse