Provider Demographics
NPI:1023279833
Name:PAUL, JEANINE P (RN)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:P
Last Name:PAUL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:P
Other - Last Name:GARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:480 GALLETTI WAY BLDG 25
Mailing Address - Street 2:ROOM #406
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-5564
Mailing Address - Country:US
Mailing Address - Phone:775-688-3367
Mailing Address - Fax:
Practice Address - Street 1:480 GALLETTI WAY BLDG 25
Practice Address - Street 2:ROOM #406
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-5564
Practice Address - Country:US
Practice Address - Phone:775-688-3367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN65516163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult