Provider Demographics
NPI:1457726085
Name:DIBENEDETTO, PAULA JEAN (ARNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:DIBENEDETTO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 N WINNSBORO ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-2144
Mailing Address - Country:US
Mailing Address - Phone:037-636-2209
Mailing Address - Fax:
Practice Address - Street 1:117 N WINNSBORO ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-2144
Practice Address - Country:US
Practice Address - Phone:037-636-2209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1077692363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology