Provider Demographics
NPI:1932296290
Name:VAUGHN, CAROL L (WHNP RNC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:L
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:WHNP RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19811 DREAMWOLD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-1502
Mailing Address - Country:US
Mailing Address - Phone:574-277-7706
Mailing Address - Fax:
Practice Address - Street 1:1733 S MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46613-2219
Practice Address - Country:US
Practice Address - Phone:574-237-6644
Practice Address - Fax:574-289-6563
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28114245A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health