Provider Demographics
NPI:1124059852
Name:RICHARDSON, PAULA C (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:C
Other - Last Name:GILDERSLEEVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3145 E CHANDLER BLVD
Mailing Address - Street 2:SUITE 110-207
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-8702
Mailing Address - Country:US
Mailing Address - Phone:602-615-9082
Mailing Address - Fax:480-634-4415
Practice Address - Street 1:3145 E CHANDLER BLVD
Practice Address - Street 2:SUITE 110-207
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-8702
Practice Address - Country:US
Practice Address - Phone:602-615-9082
Practice Address - Fax:480-634-4415
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2436363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0423330OtherBCBS AZ
AZ2Z3845OtherAZ HEALTHNET