Provider Demographics
NPI:1568801637
Name:VAUGHAN, CHRISTINE ANNE (RD, LMNT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:RD, LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 CASS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3582
Mailing Address - Country:US
Mailing Address - Phone:402-384-8668
Mailing Address - Fax:
Practice Address - Street 1:7910 CASS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3582
Practice Address - Country:US
Practice Address - Phone:402-384-8668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1084133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered