Healthcare Provider Details

I. General information

NPI: 1750438891
Provider Name (Legal Business Name): ELAINE E PASZKOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FBHC CMR 453
APO AE
09074
US

IV. Provider business mailing address

FBHC CMR 453 BOX 1218
APO AE
09074
US

V. Phone/Fax

Practice location:
  • Phone: 060631813204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN512669L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: