MEDICARE: PAULA M VASSAR NP

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	363L00000X	Nurse Practitioner	APN 0000005325	TN
2	363LF0000X	Family Nurse Practitioner	APN0000005325	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4118849	OTHER	TN	BCBS W PARADIGM

General Provider Information

NPI Number	:	1275634503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA M VASSAR NP

Provider Business Mailing Address
First Line	:	1720 E REELFOOT AVE
Second Line	:	STE 103
City	:	UNION CITY
State	:	TN
Zip	:	38261-6048
Country	:	US
Telephone Number	:	731-885-6600
Fax Number	:	731-885-9239

Provider Business Practice Location Address
First Line	:	1720 E REELFOOT AVE
Second Line	:	SUITE # 103
City	:	UNION CITY
State	:	TN
Zip	:	38261-6047
Country	:	US
Telephone Number	:	731-885-6600
Fax Number	:	731-885-9239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/12/2017

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