Provider Demographics
NPI:1154654416
Name:HAUGEN, PAULA ANDREA (NP-C)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:ANDREA
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 OLD BALLAS RD
Mailing Address - Street 2:STE 200
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-872-8740
Mailing Address - Fax:314-432-4348
Practice Address - Street 1:605 OLD BALLAS RD
Practice Address - Street 2:STE 200
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-872-8740
Practice Address - Fax:314-432-4348
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005009079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily