Provider Demographics
NPI:1972046589
Name:VAUGHN, MARISSA (RRA, RPA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:RRA, RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 ASHVILLE AVE
Mailing Address - Street 2:STE 330
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6134
Mailing Address - Country:US
Mailing Address - Phone:919-371-2371
Mailing Address - Fax:
Practice Address - Street 1:400 ASHVILLE AVE
Practice Address - Street 2:STE 330
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6134
Practice Address - Country:US
Practice Address - Phone:919-371-2371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16RRANC1002243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant