Provider Demographics
NPI:1164569737
Name:STULTZ, PAULA D (ARNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:STULTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 8TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2106
Mailing Address - Country:US
Mailing Address - Phone:319-369-4542
Mailing Address - Fax:
Practice Address - Street 1:788 8TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2106
Practice Address - Country:US
Practice Address - Phone:319-369-4542
Practice Address - Fax:319-369-4543
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA132762363L00000X
KS45671363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00649303OtherRRMCR PTAN
KSP00722394OtherRAILROAD MEDICARE PIN
KS200310550BMedicaid
KSP00722394OtherRAILROAD MEDICARE PIN
MOMA1038008Medicare PIN
MOKA1093005Medicare PIN