MEDICARE: DR. PAULA MICHELLE NORDSTROM PH.D.

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	103TC0700X	Clinical Psychologist	PSY - 303	ID

General Provider Information

NPI Number	:	1932134350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA MICHELLE NORDSTROM PH.D.

Provider Business Mailing Address
First Line	:	90 HOPE DR
Second Line	:
City	:	MOUNTAIN HOME AFB
State	:	ID
Zip	:	83648-1057
Country	:	US
Telephone Number	:	208-828-7580
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 HOPE DR
Second Line	:
City	:	MOUNTAIN HOME AFB
State	:	ID
Zip	:	83648-1057
Country	:	US
Telephone Number	:	208-828-7139
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	02/27/2026

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