Individual
CASEY VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6601 NE 78TH CT STE A3, PORTLAND, OR 97218-2823
(503) 252-3949
Mailing address
6601 NE 78TH CT STE A3, PORTLAND, OR 97218-2823
(503) 252-3949
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201406622LPN
OR
Other
Enumeration date
10/11/2019
Last updated
10/11/2019
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