Provider Demographics
NPI:1336160407
Name:MAHURIN, PAULETTE MYRA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:MYRA
Last Name:MAHURIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023
Mailing Address - Country:US
Mailing Address - Phone:805-640-0499
Mailing Address - Fax:
Practice Address - Street 1:1200 MARICOPA HIGHWAY
Practice Address - Street 2:OJAI VALLEY COMMUNITY HEALTH CENTER
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023
Practice Address - Country:US
Practice Address - Phone:805-640-8293
Practice Address - Fax:805-640-1410
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6701363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
W3731EMedicare ID - Type Unspecified
S58120Medicare UPIN