Provider Demographics
NPI:1154670149
Name:PAULSEN, DAWN L (FNP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:L
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:NY
Mailing Address - Zip Code:13803-3804
Mailing Address - Country:US
Mailing Address - Phone:607-226-2989
Mailing Address - Fax:
Practice Address - Street 1:840 HANSHAW RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1589
Practice Address - Country:US
Practice Address - Phone:607-257-6563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337425-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily