Provider Demographics
NPI:1235370479
Name:VERDE, PAULA LOUISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:LOUISE
Last Name:VERDE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:LOUISE
Other - Last Name:EPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7501 W SILVER SPRING DR APT 4
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-2736
Mailing Address - Country:US
Mailing Address - Phone:414-881-8142
Mailing Address - Fax:
Practice Address - Street 1:7501 W SILVER SPRING DR APT 4
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53218-2736
Practice Address - Country:US
Practice Address - Phone:414-881-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI304415-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35014700Medicaid