Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F304997-1 | NY |
NPI | 1023389053 |
---|---|
Provider Name | Victoria Susan Vaughan |
First Address | New York, NY 10003-9502 |
Second Address | New York, NY 10003-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |