MEDICARE: MS. VICKI LYNN VAUGHAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	209-002535	IL

General Provider Information

NPI Number	:	1669609293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VICKI LYNN VAUGHAN APN

Provider Business Mailing Address
First Line	:	445 W FULLERTON PKWY
Second Line	:	1E
City	:	CHICAGO
State	:	IL
Zip	:	60614-5185
Country	:	US
Telephone Number	:	773-615-1073
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 W FULLERTON PKWY
Second Line	:	1E
City	:	CHICAGO
State	:	IL
Zip	:	60614-5185
Country	:	US
Telephone Number	:	773-615-1073
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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