Provider Demographics
NPI:1538377221
Name:DE HART, PAULA KAY (LPN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAY
Last Name:DE HART
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 W HAYWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6921
Mailing Address - Country:US
Mailing Address - Phone:602-336-6816
Mailing Address - Fax:602-336-6964
Practice Address - Street 1:1935 W HAYWARD AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-6921
Practice Address - Country:US
Practice Address - Phone:602-336-6816
Practice Address - Fax:602-336-6964
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP010918164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse