Individual
JILLIAN VAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
301 W MYRTLE ST, BOISE, ID 83702-7656
(208) 342-8200
Mailing address
6293 N PORTSMOUTH AVE, BOISE, ID 83714-6111
(541) 961-4735
Taxonomy
Speciality
Code
Description
License number
State
163WN0800X
Neuroscience Registered Nurse
53890
ID
363LF0000X
Family Nurse Practitioner
Primary
53890
ID
Other
Enumeration date
10/21/2020
Last updated
05/04/2021
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