Healthcare Provider Details

I. General information

NPI: 1932572260
Provider Name (Legal Business Name): ROBYN ADELE VAUGHAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 N 700 W STE 250
LAYTON UT
84041-5723
US

IV. Provider business mailing address

PO BOX 5546
DENVER CO
80217-5546
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0312
  • Fax: 801-479-3364
Mailing address:
  • Phone: 801-475-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5096645-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: