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General NPI Number Information
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NPI Number | 1093175630
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Entity Type | Individual
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Provider Name | ELIZABETH BRIANNE VAUGHT NP
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Gender | Female
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Dates
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Enumeration Date | 02/24/2016
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 2150 GETTLER ST STE 400
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City | DYER
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State | IN
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Zip | 46311-2385
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Country | US
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Telephone | 219-865-0893
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Fax | 219-865-3599
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Provider Business Mailing Address
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Address Line | PO BOX 781076
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City | DETROIT
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State | MI
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Zip | 48278-1076
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Country | US
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Telephone | 317-528-4800
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Fax | 317-865-1479
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 041354593
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 209012854
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 28172376A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71006196A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71006196A
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License Number State | IN
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