Healthcare Provider Details

I. General information

NPI: 1841445665
Provider Name (Legal Business Name): ERIC JEROME PAULI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1683 GILBERT ST STE 100
NORFOLK VA
23511-2731
US

IV. Provider business mailing address

2849 CROSSINGS DR
CHESAPEAKE VA
23321-6212
US

V. Phone/Fax

Practice location:
  • Phone: 757-444-4019
  • Fax:
Mailing address:
  • Phone: 360-598-4196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN00165974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: