MEDICARE: MRS. PAULA MARY WILLETT NURSE PRACTITIONER

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	363LF0000X	Family Nurse Practitioner	615919	TX

General Provider Information

NPI Number	:	1457375552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULA MARY WILLETT NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1124 GLOUCESTER CT S
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-7505
Country	:	US
Telephone Number	:	972-252-2543
Fax Number	:

Provider Business Practice Location Address
First Line	:	6750 N MACARTHUR BLVD STE 210
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-2473
Country	:	US
Telephone Number	:	972-869-1330
Fax Number	:	972-869-1337

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	10/02/2013

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