Healthcare Provider Details

I. General information

NPI: 1720560808
Provider Name (Legal Business Name): PAULA ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E. MARTIN LUTHER KING DRIVE
CENTRALIA IL
62801
US

IV. Provider business mailing address

904 E. MARTIN LUTHER KING DRIVE
CENTRALIA IL
62801
US

V. Phone/Fax

Practice location:
  • Phone: 618-533-1391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: