Provider Demographics
NPI:1588866503
Name:VAUGHN, DONNA RAE (LPN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:RAE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 REID AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2150
Mailing Address - Country:US
Mailing Address - Phone:513-541-7748
Mailing Address - Fax:
Practice Address - Street 1:3610 W 8TH ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205-2129
Practice Address - Country:US
Practice Address - Phone:513-251-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN091205164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse