MEDICARE: KATHERINE ELIZABETH VAUGHN RDH

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	124Q00000X	Dental Hygienist	1914	NE

General Provider Information

NPI Number	:	1790989424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE ELIZABETH VAUGHN RDH

Provider Business Mailing Address
First Line	:	920 LINCOLN ST
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863-6307
Country	:	US
Telephone Number	:	308-987-2165
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 5TH STREET
Second Line	:
City	:	OVERTON
State	:	NE
Zip	:	68863
Country	:	US
Telephone Number	:	308-987-2431
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	07/08/2007

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