MEDICARE: MISS ELIZABETH BRIANNE VAUGHT NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71006196A	IN
2	163WG0000X	General Practice Registered Nurse	041354593	IL
3	163WG0000X	General Practice Registered Nurse	209012854	IL
4	163WG0000X	General Practice Registered Nurse	28172376A	IN
5	363LA2200X	Adult Health Nurse Practitioner	71006196A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093175630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH BRIANNE VAUGHT NP

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	701 SUPERIOR AVE STE 4100
Second Line	:
City	:	MUNSTER
State	:	IN
Zip	:	46321-4037
Country	:	US
Telephone Number	:	219-934-4080
Fax Number	:	219-934-4075

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	01/09/2026

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