Provider Demographics
NPI:1093988537
Name:PAULSEN, JILL M (CRNA)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E MAIN ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-1885
Mailing Address - Country:US
Mailing Address - Phone:641-752-7149
Mailing Address - Fax:641-752-6320
Practice Address - Street 1:312 E MAIN ST STE 2300
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-1885
Practice Address - Country:US
Practice Address - Phone:641-752-7149
Practice Address - Fax:641-752-6320
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD124550367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1461856OtherUMWA
IA1461856OtherUMWA