Provider Demographics
NPI:1265816961
Name:VAUGHN, JILL ANN (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 WINTERHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3678
Mailing Address - Country:US
Mailing Address - Phone:636-288-7202
Mailing Address - Fax:
Practice Address - Street 1:HUSSON UNIVERSITY WELLNESS CENTER
Practice Address - Street 2:1 COLLEGE CIRCLE
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-941-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00657363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care