Provider Demographics
NPI:1710135298
Name:EDWARDS, PAULA MARIE (L AC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:MARIE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 NE 7TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1445
Mailing Address - Country:US
Mailing Address - Phone:541-476-0187
Mailing Address - Fax:541-476-0187
Practice Address - Street 1:1228 NE 7TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1445
Practice Address - Country:US
Practice Address - Phone:541-476-0187
Practice Address - Fax:541-476-0187
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01191171100000X
CAAC12513171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist