Healthcare Provider Details

I. General information

NPI: 1679002216
Provider Name (Legal Business Name): PAULA JEAN DENOMME RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA JEAN MIX RN, BSN

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 FALLMOUTH CT
VIRGINIA BEACH VA
23464-6320
US

IV. Provider business mailing address

14121 PARKE LONG CT STE 201
CHANTILLY VA
20151-1647
US

V. Phone/Fax

Practice location:
  • Phone: 757-419-8751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001165642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: