Provider Demographics
NPI:1013607092
Name:PAULUS, DAKOTA ANTHONY (EMT)
Entity Type:Individual
Prefix:
First Name:DAKOTA
Middle Name:ANTHONY
Last Name:PAULUS
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3275
Mailing Address - Country:US
Mailing Address - Phone:541-342-8255
Mailing Address - Fax:
Practice Address - Street 1:970 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-4612
Practice Address - Country:US
Practice Address - Phone:541-778-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR205418146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic