Provider Demographics
NPI:1134222060
Name:BLACK, PAULA RATCHFORD (RN)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:RATCHFORD
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 WEST HUDSON BLVD.
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052
Mailing Address - Country:US
Mailing Address - Phone:704-853-5013
Mailing Address - Fax:704-862-5353
Practice Address - Street 1:991 WEST HUDSON BLVD.
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052
Practice Address - Country:US
Practice Address - Phone:704-853-5013
Practice Address - Fax:704-862-5353
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC152039163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator