| Organization Name: | PAULINA PEAK FAMILY HEALTHCARE INC |
| NPI Number: | 1184784332 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GREGORY L MILLER (ADMINISTRATOR) |
| Mailing Address: | 51384 Highway 97 La Pine |
| State: | OR US |
| Postal Code: | 977399871 |
| Phone Number: | 5415368060 |
| Fax Number: | |
| NPI Enumeration Date: | 12/11/2006 |
| NPI Last Update Date: | 10/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 200250124NP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |