Individual
BRIAN VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-5170
(208) 367-5180
Mailing address
PO BOX 7411114, CHICAGO, IL 60674-1114
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0000165025
TN
367500000X
Certified Registered Nurse Anesthetist
19532
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
59454
ID
Other
Enumeration date
01/08/2015
Last updated
09/29/2023
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