Provider Demographics
NPI:1780215871
Name:PAULS RHEUMATOLOGY CLINIC, INCORPORATED
Entity Type:Organization
Organization Name:PAULS RHEUMATOLOGY CLINIC, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR/ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAULS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-734-6742
Mailing Address - Street 1:224 OHARA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-9012
Mailing Address - Country:US
Mailing Address - Phone:316-734-6742
Mailing Address - Fax:
Practice Address - Street 1:24 W SUNBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1822
Practice Address - Country:US
Practice Address - Phone:316-734-6742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty