Basic Information
| Provider Information | |||||||||
| NPI: | 1093894800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAUGHN | ||||||||
| FirstName: | TRISHA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975047337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418265853 | ||||||||
| FaxNumber: | 5418265843 | ||||||||
| Practice Location | |||||||||
| Address1: | 8385 DIVISION RD | ||||||||
| Address2: | |||||||||
| City: | WHITE CITY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975031176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418265853 | ||||||||
| FaxNumber: | 5418265843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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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 | 367A00000X | CO162511 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.