Provider Demographics
NPI:1578044798
Name:VAUGHAN, VICTORIA OLUSOLA (NURSE)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:OLUSOLA
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10522 TRIPP LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2121
Mailing Address - Country:US
Mailing Address - Phone:832-692-6802
Mailing Address - Fax:
Practice Address - Street 1:10522 TRIPP LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2121
Practice Address - Country:US
Practice Address - Phone:832-692-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2018-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX852831163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse