Provider Demographics
NPI:1215926787
Name:PAULEY, MYRA LOUISE (APRN BC)
Entity type:Individual
Prefix:
First Name:MYRA
Middle Name:LOUISE
Last Name:PAULEY
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5581 S BILOXI WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5854
Mailing Address - Country:US
Mailing Address - Phone:303-750-2082
Mailing Address - Fax:303-750-6316
Practice Address - Street 1:2600 S PARKER RD
Practice Address - Street 2:#3-336
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1613
Practice Address - Country:US
Practice Address - Phone:303-750-0245
Practice Address - Fax:303-337-0271
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO162875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04009759Medicaid
CORXRN04092OtherCOLORADO BOARD OF NURSING
CO04009759Medicaid
C534998Medicare ID - Type Unspecified