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General NPI Number Information
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NPI Number | 1689371049
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Entity Type | Organization
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Legal Business Name | EMPOWERED PEDIATRICS LLC
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | W229N1433 WESTWOOD DR STE 104
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City | WAUKESHA
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State | WI
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Zip | 53186-1172
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Country | US
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Telephone | 262-307-1319
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Fax | 855-857-9099
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Provider Business Mailing Address
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Address Line | W229N1433 WESTWOOD DR STE 104
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City | WAUKESHA
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State | WI
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Zip | 53186-1172
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Country | US
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Telephone | 262-307-1319
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Fax | 855-857-9099
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | JERRICA VAUGHAN
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Credential | CPNP
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Telephone | 262-307-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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