Healthcare Provider Details

I. General information

NPI: 1659452852
Provider Name (Legal Business Name): MS. ROSE VAUGHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 BROWNTOWN ROAD
BISHOPVILLE SC
29010
US

IV. Provider business mailing address

215 N. MAGNOLIA ST.
SUMTER SC
29151-1946
US

V. Phone/Fax

Practice location:
  • Phone: 803-428-6052
  • Fax: 803-428-5406
Mailing address:
  • Phone: 803-775-9364
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: