Provider Demographics
NPI:1396970836
Name:PAUL, ALIX C (CNA 727939)
Entity type:Individual
Prefix:
First Name:ALIX
Middle Name:C
Last Name:PAUL
Suffix:
Gender:M
Credentials:CNA 727939
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5047
Mailing Address - Country:US
Mailing Address - Phone:719-635-1725
Mailing Address - Fax:719-635-1725
Practice Address - Street 1:921 HOLMES DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5047
Practice Address - Country:US
Practice Address - Phone:719-635-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO727939164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse