Healthcare Provider Details

I. General information

NPI: 1164040895
Provider Name (Legal Business Name): PAULA PHOENIX RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N LAURA RD
SPOKANE VALLEY WA
99212-2524
US

IV. Provider business mailing address

PO BOX 1046
SPOKANE VALLEY WA
99037-1046
US

V. Phone/Fax

Practice location:
  • Phone: 509-921-2753
  • Fax:
Mailing address:
  • Phone: 509-655-2218
  • Fax: 509-921-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00160708
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: