Healthcare Provider Details

I. General information

NPI: 1144293465
Provider Name (Legal Business Name): SHERRIE A VAUGHN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 07/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SANBORN AVE SUITE B
BIG RAPIDS MI
49307-1770
US

IV. Provider business mailing address

425 CHERRY ST SE
GRAND RAPIDS MI
49503-4601
US

V. Phone/Fax

Practice location:
  • Phone: 231-796-8612
  • Fax: 231-796-6305
Mailing address:
  • Phone: 616-774-7005
  • Fax: 616-774-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number4704168901
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: