Provider Demographics
NPI:1508869157
Name:KUIPER, PAULA DEANNE DIETSCH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:DEANNE DIETSCH
Last Name:KUIPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:PAULA
Other - Middle Name:DEANNE
Other - Last Name:DIETSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-413-6200
Practice Address - Fax:503-413-6422
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003216363A00000X
ORPA000475363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8420085Medicaid
WA8420085Medicaid
OR131621Medicare PIN
WA8852132Medicare PIN