Provider Demographics
NPI:1821162926
Name:PAUTZ, MAVIS JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MAVIS
Middle Name:JEAN
Last Name:PAUTZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 12TH ST
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:GIBBON
Mailing Address - State:MN
Mailing Address - Zip Code:55335
Mailing Address - Country:US
Mailing Address - Phone:507-834-6874
Mailing Address - Fax:507-834-6511
Practice Address - Street 1:535 E 12TH ST
Practice Address - Street 2:
Practice Address - City:GIBBON
Practice Address - State:MN
Practice Address - Zip Code:55335
Practice Address - Country:US
Practice Address - Phone:507-834-6874
Practice Address - Fax:507-834-6511
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR070896-2163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse