Healthcare Provider Details

I. General information

NPI: 1457426975
Provider Name (Legal Business Name): RITA K VAUGHN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BURDICK EXPY W
MINOT ND
58701-4406
US

IV. Provider business mailing address

PO BOX 5020
MINOT ND
58702-5020
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5650
  • Fax: 701-857-5031
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR18522
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: