Healthcare Provider Details

I. General information

NPI: 1871581884
Provider Name (Legal Business Name): PAULA LEWIS DEVITT RNCDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 SAINT MICHAELS DR SUITE 115
SANTA FE NM
87505-7670
US

IV. Provider business mailing address

455 SAINT MICHAELS DR MEDICAL STAFF OFFICE
SANTA FE NM
87505-7601
US

V. Phone/Fax

Practice location:
  • Phone: 505-946-4307
  • Fax: 505-946-4308
Mailing address:
  • Phone: 505-820-5227
  • Fax: 505-820-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR24250
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: