1164474409 NPI number — JULIE D VAUGHAN CRNA

Table of content: JULIE D VAUGHAN CRNA (NPI 1164474409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164474409 NPI number — JULIE D VAUGHAN CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUGHAN
Provider First Name:
JULIE
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1164474409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
988102 NEBRASKA MEDICAL CTR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68198-8102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EMILE @ 42ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68198-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-559-4081
Provider Business Practice Location Address Fax Number:
402-559-7372
Provider Enumeration Date:
05/16/2006

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: 367500000X , with the licence number:  100736 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X , with the licence number: CR000797 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 46022474348 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164474409 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47078557515 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164474409 . This is a "BCBS MN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164474409 . This is a "DAKOTACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164474409 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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