Provider Demographics
NPI:1053517805
Name:HOMBERGER, PAULA MICHELLE (PA-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:MICHELLE
Last Name:HOMBERGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:MICHELLE
Other - Last Name:CALENDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1230 BECKY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2207
Mailing Address - Country:US
Mailing Address - Phone:719-559-2305
Mailing Address - Fax:
Practice Address - Street 1:1495 GARDEN OF THE GODS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9441
Practice Address - Country:US
Practice Address - Phone:719-260-9797
Practice Address - Fax:719-260-9799
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1695363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant