Provider Demographics
NPI:1578817292
Name:VAUGHAN, TAMMY JO (NNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JO
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:JO
Other - Last Name:CHAFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-1714
Mailing Address - Fax:616-391-1332
Practice Address - Street 1:100 MICHIGAN ST NE
Practice Address - Street 2:MC 035
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2560
Practice Address - Country:US
Practice Address - Phone:616-391-1714
Practice Address - Fax:616-391-1332
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704202535363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal