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General NPI Number Information
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NPI Number | 1679690630
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Entity Type | Individual
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Provider Name | AMY MAILAND PARADIS NNP, CNS
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Gender | Female
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1441 FLORIDA AVE
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City | MODESTO
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State | CA
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Zip | 95350-4405
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Country | US
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Telephone | 209-576-3564
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Fax |
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Provider Business Mailing Address
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Address Line | 315 WILSON AVE
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City | MODESTO
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State | CA
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Zip | 95354-1454
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Country | US
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Telephone | 209-576-8783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 463713-15863
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License Number State | CA
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