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General NPI Number Information
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NPI Number | 1063783728
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Entity Type | Organization
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Legal Business Name | DR. PAULA M. NORDSTROM, LLC
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 3904 E FLAMINGO AVENUE 200
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City | NAMPA
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State | ID
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Zip | 83687-3102
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Country | US
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Telephone | 208-089-1888
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Fax | 208-839-2301
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Provider Business Mailing Address
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Address Line | 3904 E FLAMINGO AVENUE 200
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City | NAMPA
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State | ID
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Zip | 83687-3102
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Country | US
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Telephone | 208-089-1888
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Fax | 208-839-2301
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAULA MICHELLE NORDSTROM
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Credential | PH.D.
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Telephone | 208-989-1686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-303
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License Number State | ID
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