Healthcare Provider Details

I. General information

NPI: 1861724122
Provider Name (Legal Business Name): DANA E VAUGHN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 S NATIONAL AVE SUITE 430
SPRINGFIELD MO
65807-7304
US

IV. Provider business mailing address

1235 E CHEROKEE ST
SPRINGFIELD MO
65804-2203
US

V. Phone/Fax

Practice location:
  • Phone: 417-890-4100
  • Fax:
Mailing address:
  • Phone: 417-820-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number096067
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: