Provider Demographics
NPI:1952325979
Name:PAULSEN, LAURA A (ARNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:PAULSEN
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 1:629 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2330
Mailing Address - Country:US
Mailing Address - Phone:360-568-1554
Mailing Address - Fax:360-568-1722
Practice Address - Street 1:629 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2330
Practice Address - Country:US
Practice Address - Phone:360-568-1554
Practice Address - Fax:360-568-1722
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004816363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9609223Medicaid
WA500018413OtherMEDICARE RAILROAD
WAAB20846Medicare ID - Type Unspecified
WAS61507Medicare UPIN