Provider Demographics
NPI:1760683791
Name:PAUL, NANCY LOU
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LOU
Last Name:PAUL
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 1:714 COVINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356
Mailing Address - Country:US
Mailing Address - Phone:937-778-9539
Mailing Address - Fax:
Practice Address - Street 1:714 COVINGTON AVE
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-3207
Practice Address - Country:US
Practice Address - Phone:937-778-9539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2479232374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide