Provider Demographics
NPI:1598816860
Name:PAULSEN, DEBBIE JEAN (PA)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:JEAN
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:JEAN
Other - Last Name:DEPPMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:900 N ORANGE ST
Mailing Address - Street 2:STE 303
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-2956
Mailing Address - Country:US
Mailing Address - Phone:406-728-3111
Mailing Address - Fax:406-728-3116
Practice Address - Street 1:900 N ORANGE ST
Practice Address - Street 2:STE 303
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-2956
Practice Address - Country:US
Practice Address - Phone:406-728-3111
Practice Address - Fax:406-728-3116
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT496363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000900003OtherBLUE CROSS BLUE SHIELD
MT1598816860Medicaid