Provider Demographics
NPI:1871581884
Name:DEVITT, PAULA LEWIS (RNCDE)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:LEWIS
Last Name:DEVITT
Suffix:
Gender:F
Credentials:RNCDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SAINT MICHAELS DR
Mailing Address - Street 2:MEDICAL STAFF OFFICE
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7601
Mailing Address - Country:US
Mailing Address - Phone:505-820-5227
Mailing Address - Fax:505-820-5645
Practice Address - Street 1:465 SAINT MICHAELS DR
Practice Address - Street 2:SUITE 115
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7670
Practice Address - Country:US
Practice Address - Phone:505-946-4307
Practice Address - Fax:505-946-4308
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR24250163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM006293OtherBCBS OF NEW MEXICO
NMPROVP12386OtherHEALTH INSURANCE