Basic Information
Provider Information
NPI: 1932572260
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAUGHAN
FirstName: ROBYN
MiddleName: ADELE
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5546
Address2:  
City: DENVER
State: CO
PostalCode: 802175546
CountryCode: US
TelephoneNumber: 8014753500
FaxNumber:  
Practice Location
Address1: 1916 N 700 W STE 250
Address2:  
City: LAYTON
State: UT
PostalCode: 840415723
CountryCode: US
TelephoneNumber: 8014790312
FaxNumber: 8014793364
Other Information
ProviderEnumerationDate: 11/09/2015
LastUpdateDate: 09/09/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X5096645-4405UTY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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