Provider Demographics
NPI:1407148398
Name:PAULSEN, CRISTIANNE (RDH)
Entity Type:Individual
Prefix:MS
First Name:CRISTIANNE
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SW STARK, FLOOR 9
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204
Mailing Address - Country:US
Mailing Address - Phone:503-988-3674
Mailing Address - Fax:
Practice Address - Street 1:426 SW STARK, 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204
Practice Address - Country:US
Practice Address - Phone:503-988-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4696124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH4696OtherRDH