Provider Demographics
NPI:1750950846
Name:PAUL, NYSSA RUTH
Entity type:Individual
Prefix:MS
First Name:NYSSA
Middle Name:RUTH
Last Name:PAUL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NYSSA
Other - Middle Name:BRIANNA
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4580 NW UNIVERSITY PL APT 4
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-1669
Mailing Address - Country:US
Mailing Address - Phone:541-223-1183
Mailing Address - Fax:
Practice Address - Street 1:330 NE KIRBY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4301
Practice Address - Country:US
Practice Address - Phone:971-901-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst