Provider Demographics
NPI:1235319625
Name:VAUGHAN, DAVID J (FNP)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:VAUGHAN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SIX TRACT LANE
Mailing Address - Street 2:P.O. BOX 1029
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-1029
Mailing Address - Country:US
Mailing Address - Phone:406-745-2781
Mailing Address - Fax:406-745-3080
Practice Address - Street 1:330 SIX TRACT LANE
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-1029
Practice Address - Country:US
Practice Address - Phone:406-745-2781
Practice Address - Fax:406-745-3080
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT28637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily