Provider Demographics
NPI:1023274750
Name:VAUGHN, TREASURE MARAE (APRN)
Entity type:Individual
Prefix:
First Name:TREASURE
Middle Name:MARAE
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29055 CLEMENS RD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1135
Mailing Address - Country:US
Mailing Address - Phone:216-450-1613
Mailing Address - Fax:
Practice Address - Street 1:77 HAZZARD CREEK VLG UNIT C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-8266
Practice Address - Country:US
Practice Address - Phone:843-645-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH425109163W00000X
OH130329164W00000X
OH0029914363LP0808X
SC25822363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse