MEDICARE: PAULA K DEANDA 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	363LA2100X	Acute Care Nurse Practitioner	RN100957	AZ
2	363LF0000X	Family Nurse Practitioner	AP 1757	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831178912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA K DEANDA NP

Provider Business Mailing Address
First Line	:	1950 W PASEO MONSERRAT
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1329
Country	:	US
Telephone Number	:	520-465-8373
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 N CENTRAL AVE
Second Line	:	SUITE 800
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2902
Country	:	US
Telephone Number	:	602-462-1132
Fax Number	:	844-877-3840

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	08/05/2015

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