Provider Demographics
NPI:1851392963
Name:PAULUS, VICTORIA DAWN (ARNP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:DAWN
Last Name:PAULUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 NE 77TH AVE STE 275
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6857
Mailing Address - Country:US
Mailing Address - Phone:360-597-4798
Mailing Address - Fax:360-859-3488
Practice Address - Street 1:7600 NE 41ST ST
Practice Address - Street 2:STE 310
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6791
Practice Address - Country:US
Practice Address - Phone:360-571-2050
Practice Address - Fax:360-253-3196
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004268363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9620147Medicaid
WA9620147Medicaid
WAAB02262Medicare ID - Type Unspecified