Provider Demographics
NPI:1770618357
Name:LAVOIE-VAUGHAN, NANETTE LOUISE (ARNP-C)
Entity type:Individual
Prefix:
First Name:NANETTE
Middle Name:LOUISE
Last Name:LAVOIE-VAUGHAN
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:NANETTE
Other - Middle Name:LOUISE
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3819 DONNA RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4226
Mailing Address - Country:US
Mailing Address - Phone:919-971-6614
Mailing Address - Fax:
Practice Address - Street 1:5407 SKY LANE DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3953
Practice Address - Country:US
Practice Address - Phone:919-682-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165493363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC900203Medicare UPIN