Provider Demographics
NPI:1275634503
Name:VASSAR, PAULA M (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:VASSAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:HUTCHINS
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 E REELFOOT AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-6048
Mailing Address - Country:US
Mailing Address - Phone:731-885-6600
Mailing Address - Fax:731-885-9239
Practice Address - Street 1:1720 E REELFOOT AVE
Practice Address - Street 2:SUITE # 103
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6047
Practice Address - Country:US
Practice Address - Phone:731-885-6600
Practice Address - Fax:731-885-9239
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN 0000005325363L00000X
TNAPN0000005325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4118849OtherBCBS W PARADIGM
TNS27242Medicare UPIN
TNS27242Medicare UPIN
TN4118849OtherBCBS W PARADIGM
TN3343235Medicare PIN