Healthcare Provider Details

I. General information

NPI: 1316381122
Provider Name (Legal Business Name): PAULA FORTUNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HIGHLAND RD
SOUTH HAMPTON NH
03827-3607
US

IV. Provider business mailing address

32 HIGHLAND RD
SOUTH HAMPTON NH
03827-3607
US

V. Phone/Fax

Practice location:
  • Phone: 603-394-7052
  • Fax:
Mailing address:
  • Phone: 603-394-7052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number159433
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN159433
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number159433
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: