Provider Demographics
NPI:1538655998
Name:VAUGHN, MICHAEL ANN (DNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANN
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ANN
Other - Last Name:MCINERNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 N 84TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4239
Mailing Address - Country:US
Mailing Address - Phone:406-220-2120
Mailing Address - Fax:
Practice Address - Street 1:5150 VILLAGE PARK DR SE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006
Practice Address - Country:US
Practice Address - Phone:425-657-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60860634363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60860634OtherWASHINGTON STATE DEPARTMENT OF HEALTH