Provider Demographics
NPI:1740762756
Name:PAULSON, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:PAULSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7372 ADAIR CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2090
Mailing Address - Country:US
Mailing Address - Phone:612-964-4171
Mailing Address - Fax:
Practice Address - Street 1:7372 ADAIR CT N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2090
Practice Address - Country:US
Practice Address - Phone:612-964-4171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist