Provider Demographics
NPI:1497577233
Name:VAUGHAN, KALU JANE (CPM, CDEM)
Entity type:Individual
Prefix:
First Name:KALU
Middle Name:JANE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:CPM, CDEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-1679
Mailing Address - Country:US
Mailing Address - Phone:317-340-3583
Mailing Address - Fax:
Practice Address - Street 1:412 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:FORTVILLE
Practice Address - State:IN
Practice Address - Zip Code:46040-1679
Practice Address - Country:US
Practice Address - Phone:317-340-3583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN90000023A176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife