Provider Demographics
NPI:1922097393
Name:PAOLINELLI, KAREN GRACE (NP AND PA)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:GRACE
Last Name:PAOLINELLI
Suffix:
Gender:F
Credentials:NP AND PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5942
Mailing Address - Country:US
Mailing Address - Phone:559-675-5530
Mailing Address - Fax:559-675-5532
Practice Address - Street 1:1210 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:559-675-5530
Practice Address - Fax:559-675-5532
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13161363A00000X
CA411424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ40408ZOtherBLUE SHIELD
CAP17043Medicare UPIN
CAZZZ19065ZMedicare ID - Type Unspecified