Provider Demographics
NPI:1790303006
Name:VAUGHAN, ELIZABETH (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 WHITE CLIFF LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27712-9557
Mailing Address - Country:US
Mailing Address - Phone:608-335-8581
Mailing Address - Fax:
Practice Address - Street 1:10580 LIGON MILL RD # 210
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6090
Practice Address - Country:US
Practice Address - Phone:919-263-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
NC5013330363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No251S00000XAgenciesCommunity/Behavioral Health