Provider Demographics
NPI:1669615076
Name:PAUL, PATRICIA ARLENE (RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ARLENE
Last Name:PAUL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:ARLENE
Other - Last Name:FUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4601 CRYSTALWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5823
Mailing Address - Country:US
Mailing Address - Phone:757-403-3048
Mailing Address - Fax:
Practice Address - Street 1:1220 BLAIR MILL RD
Practice Address - Street 2:APT 1101
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4862
Practice Address - Country:US
Practice Address - Phone:301-850-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001087910163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse