Basic Information
| Provider Information | |||||||||
| NPI: | 1063609287 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAUGHAN | ||||||||
| FirstName: | POLLY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6100 GURNEYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451776508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373134400 | ||||||||
| FaxNumber: | 9374881414 | ||||||||
| Practice Location | |||||||||
| Address1: | 630 EATON AVE # 2W | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138672433 | ||||||||
| FaxNumber: | 5138672499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.09551 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | NP-09551 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0808X | APRN.CNP.09551 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.