Provider Demographics
NPI:1629689773
Name:PAULOVICH, MALEAH
Entity Type:Individual
Prefix:
First Name:MALEAH
Middle Name:
Last Name:PAULOVICH
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 1:1901 ENCORE WAY
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-8896
Mailing Address - Country:US
Mailing Address - Phone:501-794-9021
Mailing Address - Fax:
Practice Address - Street 1:1901 ENCORE WAY
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-8896
Practice Address - Country:US
Practice Address - Phone:501-794-9021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant