Provider Demographics
NPI:1275965675
Name:PAULUS, KRISTIN R (CPM)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:R
Last Name:PAULUS
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20336 FAYETTEVILLE BLANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45118-8432
Mailing Address - Country:US
Mailing Address - Phone:513-722-5678
Mailing Address - Fax:
Practice Address - Street 1:20336 FAYETTEVILLE BLANCHESTER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45118-8432
Practice Address - Country:US
Practice Address - Phone:513-722-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
OH374J00000X374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH99499OtherDOULA
83-0824675OtherMIDWIFE CPM