Individual
BRYCE VAUGHAN-MAE NORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
12560 STATE ROUTE 405, WATSONTOWN, PA 17777-8525
(570) 538-2501
(570) 538-3227
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061701
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1038286920001
—
PA
01
—
1I4731
MEDICARE
PA
Enumeration date
08/05/2020
Last updated
02/03/2022
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