Provider Demographics
NPI:1790183549
Name:EASTMAN, PAULA SUSAN (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUSAN
Last Name:EASTMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:SUSAN
Other - Last Name:TAKACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:10008 LADDER RANCH LANE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121
Mailing Address - Country:US
Mailing Address - Phone:505-240-5078
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF NEW MEXICO HOSPITAL
Practice Address - Street 2:2600 MARBLE DR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-272-3592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-10
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02875363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health