Provider Demographics
NPI:1104596089
Name:VAUGHAN, DENISE MICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:VAUGHAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3115
Mailing Address - Country:US
Mailing Address - Phone:804-673-5241
Mailing Address - Fax:804-977-6244
Practice Address - Street 1:4926 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3122
Practice Address - Country:US
Practice Address - Phone:804-673-5241
Practice Address - Fax:804-977-6244
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001279908163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult