Provider Demographics
NPI:1306014600
Name:ENTWISTLE, PAULA SUZANNE
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUZANNE
Last Name:ENTWISTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6972
Mailing Address - Country:US
Mailing Address - Phone:239-369-0522
Mailing Address - Fax:239-369-0522
Practice Address - Street 1:120 AIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6972
Practice Address - Country:US
Practice Address - Phone:239-369-0522
Practice Address - Fax:239-369-0522
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health