Provider Demographics
NPI:1265794002
Name:WHITTLE, PAULA ANN (APRN)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANN
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 S 133RD ST STE 109
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1133
Mailing Address - Country:US
Mailing Address - Phone:401-614-0010
Mailing Address - Fax:402-614-0090
Practice Address - Street 1:4610 S 133RD ST STE 109
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-614-0010
Practice Address - Fax:402-614-0090
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health