Provider Demographics
NPI:1871719039
Name:NUTTALL, PAULA ANNE
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANNE
Last Name:NUTTALL
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 1:2920 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-5107
Mailing Address - Country:US
Mailing Address - Phone:520-459-2268
Mailing Address - Fax:
Practice Address - Street 1:5225 E BUENA SCHOOL BLVD
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2392
Practice Address - Country:US
Practice Address - Phone:520-515-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5447235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist