Healthcare Provider Details

I. General information

NPI: 1699717702
Provider Name (Legal Business Name): LAURA VAUGHAN MRNUSTIK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 06/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 N MACARTHUR BLVD BLDG. 2, SUITE 350
IRVING TX
75039-2875
US

IV. Provider business mailing address

9003 AIRPORT FWY SUITE 300
NORTH RICHLAND HILLS TX
76180-7770
US

V. Phone/Fax

Practice location:
  • Phone: 972-556-1616
  • Fax: 972-556-1740
Mailing address:
  • Phone: 817-514-5200
  • Fax: 817-514-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number709435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: