Provider Demographics
NPI:1467430330
Name:VAUGHAN, DIANNA R (ARNP)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:R
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 MERIDIAN S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7516
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-446-3239
Practice Address - Street 1:1706 MERIDIAN S
Practice Address - Street 2:SUITE 120
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7516
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-446-3239
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163799OtherLABOR & INDUSTRY NUMBER
WA8403024OtherDSHS NUMBER