Healthcare Provider Details

I. General information

NPI: 1497292221
Provider Name (Legal Business Name): PARADIGM INNOVATIVE HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92302 E HOLLY RD
KENNEWICK WA
99338-8336
US

IV. Provider business mailing address

92302 E HOLLY RD
KENNEWICK WA
99338-8336
US

V. Phone/Fax

Practice location:
  • Phone: 509-378-4227
  • Fax:
Mailing address:
  • Phone: 509-378-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60310239
License Number StateWA

VIII. Authorized Official

Name: JOLENE CULVER
Title or Position: OWNER
Credential: ARNP
Phone: 509-378-4227