Provider Demographics
NPI:1083108039
Name:PAULSEN, PAULA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MARIE
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O BOX 29650
Mailing Address - Street 2:DEPT # 880386
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038
Mailing Address - Country:US
Mailing Address - Phone:469-320-1267
Mailing Address - Fax:469-320-1268
Practice Address - Street 1:1305 AIRPORT FWY STE 103
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6603
Practice Address - Country:US
Practice Address - Phone:469-320-1267
Practice Address - Fax:469-320-1268
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2846363LA2200X
TX1040937363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health