=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265816961
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL ANN VAUGHN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2015
-----------------------------------------------------
Last Update Date | 12/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HUSSON UNIVERSITY WELLNESS CENTER 1 COLLEGE CIRCLE
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-941-1050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 WINTERHAVEN DR
-----------------------------------------------------
City | ORONO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04473-3678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-288-7202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN00657
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------