Provider Demographics
NPI:1407067341
Name:MATTHEW, PAULA ELAINE (LM CPM)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ELAINE
Last Name:MATTHEW
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:SKULL VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86338
Mailing Address - Country:US
Mailing Address - Phone:928-776-8033
Mailing Address - Fax:928-776-4038
Practice Address - Street 1:715 RUTH ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-776-8033
Practice Address - Fax:928-776-4038
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
97050005176B00000X
AZ062176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife