Provider Demographics
NPI:1649583204
Name:DAVIS, PAULA BYRNE (FNP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:BYRNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:SUE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6425 W MISSION LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-4015
Mailing Address - Country:US
Mailing Address - Phone:623-934-7770
Mailing Address - Fax:623-845-3834
Practice Address - Street 1:6425 W MISSION LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-4015
Practice Address - Country:US
Practice Address - Phone:623-934-7770
Practice Address - Fax:623-845-3834
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 0843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD 0548846OtherDEA#