MEDICARE: PAULA LEWIS DEVITT RNCDE

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	163WD0400X	Diabetes Educator Registered Nurse	R24250	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM006293	OTHER	NM	BCBS OF NEW MEXICO
2	PROVP12386	OTHER	NM	HEALTH INSURANCE

General Provider Information

NPI Number	:	1871581884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA LEWIS DEVITT RNCDE

Provider Business Mailing Address
First Line	:	455 SAINT MICHAELS DR
Second Line	:	MEDICAL STAFF OFFICE
City	:	SANTA FE
State	:	NM
Zip	:	87505-7601
Country	:	US
Telephone Number	:	505-820-5227
Fax Number	:	505-820-5645

Provider Business Practice Location Address
First Line	:	465 SAINT MICHAELS DR
Second Line	:	SUITE 115
City	:	SANTA FE
State	:	NM
Zip	:	87505-7670
Country	:	US
Telephone Number	:	505-946-4307
Fax Number	:	505-946-4308

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/19/2008

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Directions to “ PAULA LEWIS DEVITT RNCDE” Practice Location

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