Provider Demographics
NPI:1841486743
Name:STUART, PAULA MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:MICHELLE
Last Name:STUART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 WALLRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-8736
Mailing Address - Country:US
Mailing Address - Phone:336-922-5534
Mailing Address - Fax:
Practice Address - Street 1:WFUBMC DEPT OF EMERGENCY MEDICINE
Practice Address - Street 2:MEDICAL CENTER BLVD
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-8730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9882106OtherAETNA
NC203925OtherMEDCOST
NC9882106OtherAETNA