| NPI | 1194798488 | 
|---|---|
| Former Name | PAULA K WILLENBORG | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IA J050653)  | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA 050653)  | 
| Enumeration Date | 2006-02-08 | 
| Last Update Date | 2019-06-28 |