MEDICARE: PAULA A WHITTLE MENTAL HEALTH SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	111379	NE

General Provider Information

NPI Number	:	1033474275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAULA A WHITTLE MENTAL HEALTH SERVICES PC

Provider Business Mailing Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Provider Business Practice Location Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Authorized Official
Title or Position	:	OWNER
Name	:	PAULA ANN WHITTLE
Credential	:	APRN
Telephone Number	:	402-614-0010

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	09/19/2018

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