Provider Demographics
NPI:1164526653
Name:VAUGHN, LAURIE G (CRNA, BSN)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:G
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:CRNA, BSN
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:JEANNE
Other - Last Name:GIRARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 NORTH WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-774-8726
Mailing Address - Fax:803-774-9846
Practice Address - Street 1:2720 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4810
Practice Address - Country:US
Practice Address - Phone:803-791-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26177367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0245Medicaid
SCAN0245Medicaid
SCQ275227136Medicare PIN
SCQ275221729Medicare PIN
SCQ275221236Medicare PIN