Provider Demographics
NPI:1942285630
Name:VAUGHN-DICKMAN, ERRAIN DYAN (OPA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERRAIN
Middle Name:DYAN
Last Name:VAUGHN-DICKMAN
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:MRS
Other - First Name:ERRAIN
Other - Middle Name:DYAN
Other - Last Name:VAUGHN-DICKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OPA-C
Mailing Address - Street 1:1100 HERCULES AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2758
Mailing Address - Country:US
Mailing Address - Phone:281-335-1111
Mailing Address - Fax:281-286-3392
Practice Address - Street 1:1100 HERCULES AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2720
Practice Address - Country:US
Practice Address - Phone:281-335-1111
Practice Address - Fax:281-286-9250
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX935246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist