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General NPI Number Information
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NPI Number | 1790392280
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Entity Type | Individual
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Provider Name | PAULINA MORA CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 2737 S 7TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47802-3509
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Country | US
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Telephone | 812-231-4608
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Fax |
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Provider Business Mailing Address
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Address Line | 103 S 23RD ST
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City | TERRE HAUTE
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State | IN
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Zip | 47803-1831
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Country | US
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Telephone | 312-813-0338
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041406983
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 135409
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License Number State | IN
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