Provider Demographics
NPI:1821714643
Name:WYATT, PAULA (MA, BSN, RN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WYATT
Suffix:
Gender:F
Credentials:MA, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-8368
Mailing Address - Country:US
Mailing Address - Phone:208-659-1253
Mailing Address - Fax:
Practice Address - Street 1:3201 S WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-8368
Practice Address - Country:US
Practice Address - Phone:208-659-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN-60135523163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse