Provider Demographics
NPI:1831469147
Name:PAULSEN, FREDERICK POPE (ACNP - BC)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:POPE
Last Name:PAULSEN
Suffix:
Gender:M
Credentials:ACNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-0492
Mailing Address - Country:US
Mailing Address - Phone:603-724-5983
Mailing Address - Fax:
Practice Address - Street 1:1401 S CASCADE AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5003
Practice Address - Country:US
Practice Address - Phone:603-724-5983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP-990081363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care