Provider Demographics
NPI:1659713113
Name:VAUGHN, AMELIA (AMELIA VAUGHN)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:AMELIA VAUGHN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AMY VAUGHN
Mailing Address - Street 1:118 ECHO AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4367
Mailing Address - Country:US
Mailing Address - Phone:510-418-1020
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA743012163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse