Individual
ELLEN VAUGHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3820 LAKE OTIS PKWY STE 105, ANCHORAGE, AK 99508-5209
(907) 351-6875
Mailing address
3820 LAKE OTIS PKWY STE 105, ANCHORAGE, AK 99508-5209
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
01/13/2016
Last updated
01/13/2016
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