Provider Demographics
NPI:1972053072
Name:PAULSON, LAURA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MARIE
Other - Last Name:TENNANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4088 E JASPER DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-8460
Mailing Address - Country:US
Mailing Address - Phone:928-425-8200
Mailing Address - Fax:928-425-8406
Practice Address - Street 1:1100 N BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:GLOBE
Practice Address - State:AZ
Practice Address - Zip Code:85501-2757
Practice Address - Country:US
Practice Address - Phone:928-425-8200
Practice Address - Fax:928-425-8406
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6466363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical