Provider Demographics
NPI:1639068893
Name:MARY PARADIS PROFESSIONAL NURSING PC
Entity type:Organization
Organization Name:MARY PARADIS PROFESSIONAL NURSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARADIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-677-9098
Mailing Address - Street 1:21990 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21990 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-8637
Practice Address - Country:US
Practice Address - Phone:661-677-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty