Healthcare Provider Details

I. General information

NPI: 1124059852
Provider Name (Legal Business Name): PAULA C RICHARDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA C GILDERSLEEVE PA-C

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 E CHANDLER BLVD SUITE 110-207
PHOENIX AZ
85048-8702
US

IV. Provider business mailing address

3145 E CHANDLER BLVD SUITE 110-207
PHOENIX AZ
85048-8702
US

V. Phone/Fax

Practice location:
  • Phone: 602-615-9082
  • Fax: 480-634-4415
Mailing address:
  • Phone: 602-615-9082
  • Fax: 480-634-4415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2436
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: