Individual
STEVE VAUGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
201 CEDAR ST SE STE 800, ALBUQUERQUE, NM 87106-4912
(505) 563-2500
(505) 563-2531
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP-03576
NM
363LP2300X
Primary Care Nurse Practitioner
CNP-03576
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19489709
—
NM
Enumeration date
05/10/2018
Last updated
09/01/2020
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