Provider Demographics
NPI:1588185888
Name:VAUGHN, DIANA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:MUGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MC LEANSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62859-0429
Mailing Address - Country:US
Mailing Address - Phone:618-643-2361
Mailing Address - Fax:618-643-2502
Practice Address - Street 1:1112 OAK ST STE 102
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1344
Practice Address - Country:US
Practice Address - Phone:618-382-5985
Practice Address - Fax:855-827-3536
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041290795363LF0000X
IL209.016082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily