Provider Demographics
NPI:1396389797
Name:MOORE, PAULA AUSMUS
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:AUSMUS
Last Name:MOORE
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 1:1900 DENNIS FLAT RD.
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823
Mailing Address - Country:US
Mailing Address - Phone:775-340-5943
Mailing Address - Fax:
Practice Address - Street 1:1900 DENNIS FLAT RD.
Practice Address - Street 2:
Practice Address - City:DEETH
Practice Address - State:NV
Practice Address - Zip Code:89823
Practice Address - Country:US
Practice Address - Phone:775-340-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician