Healthcare Provider Details

I. General information

NPI: 1700548856
Provider Name (Legal Business Name): PAULA MAST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 COMMERCE WAY
DOVER DE
19904-8210
US

IV. Provider business mailing address

198 COMMERCE WAY
DOVER DE
19904-8210
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-1500
  • Fax:
Mailing address:
  • Phone: 302-672-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0046380
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: