Individual
TINA VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7804 YAKIMA AVE, TACOMA, WA 98408-5317
(253) 282-0262
Mailing address
6018 122ND ST E, PUYALLUP, WA 98373-8109
(253) 282-0262
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
823201241
—
WA
Enumeration date
09/27/2021
Last updated
09/27/2021
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