Provider Demographics
NPI:1700911898
Name:PAUL, MARY BETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 W BOCA RATON RD
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-4903
Mailing Address - Country:US
Mailing Address - Phone:623-760-3153
Mailing Address - Fax:
Practice Address - Street 1:12725 W BOCA RATON RD
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-4903
Practice Address - Country:US
Practice Address - Phone:623-760-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164W00000X164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse