Provider Demographics
NPI:1265297139
Name:BASS, PAULA DENISE (BSN, RN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:DENISE
Last Name:BASS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 CASSINI AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-7224
Mailing Address - Country:US
Mailing Address - Phone:912-596-1995
Mailing Address - Fax:
Practice Address - Street 1:6849 CASSINI AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-7224
Practice Address - Country:US
Practice Address - Phone:912-596-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54727163WC0400X, 163WE0003X, 163W00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No251B00000XAgenciesCase Management