1407859416 NPI number — JEANNETTE VAUGHN-DOTTERER P.A.-C.

Table of content: JEANNETTE VAUGHN-DOTTERER P.A.-C. (NPI 1407859416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407859416 NPI number — JEANNETTE VAUGHN-DOTTERER P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHN-DOTTERER
Provider First Name:
JEANNETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407859416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10097
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CASA GRANDE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85230-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-836-3446
Provider Business Mailing Address Fax Number:
520-836-8807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
865 N ARIZOLA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASA GRANDE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85222-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-836-3446
Provider Business Practice Location Address Fax Number:
520-836-8807
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  2896 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com