Provider Demographics
NPI:1790214930
Name:PAULL, CAROLINE RUTH (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:RUTH
Last Name:PAULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7231
Mailing Address - Country:US
Mailing Address - Phone:262-654-0491
Mailing Address - Fax:
Practice Address - Street 1:3601 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7231
Practice Address - Country:US
Practice Address - Phone:262-654-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7698-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily