Provider Demographics
NPI:1104702612
Name:ANDERSON, PAULA GRAVES
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:GRAVES
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 851171
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1171
Mailing Address - Country:US
Mailing Address - Phone:972-743-5123
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 851171
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75185-1171
Practice Address - Country:US
Practice Address - Phone:972-743-5123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider