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NPI Code Detail

MEDICARE: PAULA KAY DE HART LPN

MEDICARE: PAULA KAY DE HART LPN
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
1164W00000XLicensed Practical NurseLP010918AZ

General Provider Information

NPI Number : 1538377221
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULA KAY DE HART LPN
Provider Business Mailing Address
First Line : 1935 W HAYWARD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-6921
Country : US
Telephone Number : 602-336-6816
Fax Number : 602-336-6964
Provider Business Practice Location Address
First Line : 1935 W HAYWARD AVE
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-6921
Country : US
Telephone Number : 602-336-6816
Fax Number : 602-336-6964
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2007
Last Update Date : 07/08/2007

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Directions to “ PAULA KAY DE HART LPN” Practice Location

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