Provider Demographics
NPI:1215100219
Name:CHILDERS, PAULA SANDRA (RN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:SANDRA
Last Name:CHILDERS
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 1:4504 CHRISTINA LN
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1100
Mailing Address - Country:US
Mailing Address - Phone:614-478-7408
Mailing Address - Fax:
Practice Address - Street 1:4504 CHRISTINA LN
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-1100
Practice Address - Country:US
Practice Address - Phone:614-478-7408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN288133163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse