Provider Demographics
NPI:1992047666
Name:YVONNE, PAULA (RN, BSN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:YVONNE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 NW BEAVER ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1802
Mailing Address - Country:US
Mailing Address - Phone:541-447-5165
Mailing Address - Fax:
Practice Address - Street 1:375 NW BEAVER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-447-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200640348RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health