Provider Demographics
NPI:1417966565
Name:CARLTON, PAULA (APNP)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:
Last Name:CARLTON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:205 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-5312
Practice Address - Country:US
Practice Address - Phone:262-338-1123
Practice Address - Fax:262-338-7681
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1533-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIP00941429OtherRR MEDICARE
WI019940011Medicare PIN
WI462360403Medicare PIN