Basic Information
| Provider Information | |||||||||
| NPI: | 1790392280 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORA | ||||||||
| FirstName: | PAULINA | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 S 23RD ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478031831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128130338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2737 S 7TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478023509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122314608 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2020 | ||||||||
| LastUpdateDate: | 09/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041406983 | IL | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 367500000X | 135409 | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.