Healthcare Provider Details

I. General information

NPI: 1922793298
Provider Name (Legal Business Name): JULIE MARIE VAUGHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 BELLWEST BLVD
BELLEVILLE WI
53508-9433
US

IV. Provider business mailing address

PO BOX 70
PRAIRIE DU SAC WI
53578-0070
US

V. Phone/Fax

Practice location:
  • Phone: 608-424-3384
  • Fax: 608-424-6353
Mailing address:
  • Phone: 608-643-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84786-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: