Provider Demographics
NPI:1346398039
Name:PAUL, CAROL A
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:A
Last Name:PAUL
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 1:10128 TUMBLEWEED BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2632
Mailing Address - Country:US
Mailing Address - Phone:260-918-3333
Mailing Address - Fax:
Practice Address - Street 1:10128 TUMBLEWEED BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2632
Practice Address - Country:US
Practice Address - Phone:260-918-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging