Provider Demographics
NPI:1376875716
Name:VAUGHAN, DEBORAH (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:
Other - Last Name:HENDRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-942-6100
Mailing Address - Fax:312-942-6653
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:SUITE 550
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-942-6100
Practice Address - Fax:312-942-6653
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-005205363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical