Healthcare Provider Details

I. General information

NPI: 1851107114
Provider Name (Legal Business Name): MIKAYLA VAUGHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE
HOBART IN
46342-6699
US

IV. Provider business mailing address

311 E 125TH AVE
CROWN POINT IN
46307-8076
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6200
  • Fax:
Mailing address:
  • Phone: 219-713-3886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28259068A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: