Provider Demographics
NPI:1639148794
Name:PAULSEN, RICHARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2635 G ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2813
Mailing Address - Country:US
Mailing Address - Phone:661-633-1500
Mailing Address - Fax:661-633-2700
Practice Address - Street 1:2615 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2014
Practice Address - Country:US
Practice Address - Phone:661-869-6194
Practice Address - Fax:661-869-6975
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN483547367500000X
CANA2476367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN483547Medicaid
CARN483547Medicaid
CAZZZ19819ZMedicare PIN
CAAZ153ZMedicare PIN
CACA188115Medicare PIN
CAZZZ34009ZMedicare PIN