Healthcare Provider Details

I. General information

NPI: 1013130707
Provider Name (Legal Business Name): PAULA EVON JOHNSONBINGHAM LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HANAU HEALTH CLINIC UNIT 20193 BOX 0030
APO AE
09165
DE

IV. Provider business mailing address

USAG HESSEN CMR 470 BOX 7683
APO AE
09165
DE

V. Phone/Fax

Practice location:
  • Phone: 3286656
  • Fax:
Mailing address:
  • Phone: 3286656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number174463
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: