Individual
JUSTIN T VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER, TACOMA, WA 98431-0001
(253) 968-1110
Mailing address
MADIGAN ARMY MEDICAL CTR, 9040 A REID ST, TACOMA, WA 98431-0001
(253) 968-1110
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN00162696
WA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP300007207
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039515
L&I
WA
01
—
3350VA
INDIVIDUAL BLUE SHIELD
WA
Enumeration date
05/12/2006
Last updated
08/21/2024
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