=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407067341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA ELAINE MATTHEW LM CPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 715 RUTH ST
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-776-8033
-----------------------------------------------------
Fax | 928-776-4038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 103
-----------------------------------------------------
City | SKULL VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-776-8033
-----------------------------------------------------
Fax | 928-776-4038
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 97050005
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | 062
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------