Provider Demographics
NPI:1790032696
Name:PAULSEN, KATHERINE M (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:M
Other - Last Name:OLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1200 OAKLEAF WAY STE A
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-832-1400
Mailing Address - Fax:715-832-4187
Practice Address - Street 1:1200 OAKLEAF WAY STE A
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-832-1400
Practice Address - Fax:715-832-4187
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4340363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1790032696Medicaid