Provider Demographics
NPI:1568637817
Name:VAUGHN, LANA SUE
Entity Type:Individual
Prefix:MS
First Name:LANA
Middle Name:SUE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:SUE
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COTA
Mailing Address - Street 1:218 MERCER LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-7251
Mailing Address - Country:US
Mailing Address - Phone:501-665-3141
Mailing Address - Fax:
Practice Address - Street 1:218 MERCER LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:AR
Practice Address - Zip Code:71929-7251
Practice Address - Country:US
Practice Address - Phone:501-865-3141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant