Individual
LATONYA SHINESE VAUGHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4149 W 79TH ST UNIT 2, CHICAGO, IL 60652-2329
(773) 407-0559
Mailing address
4149 W 79TH ST UNIT 2, CHICAGO, IL 60652-2329
(773) 407-0559
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.405551
IL
363LF0000X
Family Nurse Practitioner
Primary
209018648
IL
Other
Enumeration date
11/01/2018
Last updated
06/29/2023
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