Provider Demographics
NPI:1013986371
Name:PAULSEN, MICHELLE L (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:FULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:675 E NICOLLET BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-6749
Mailing Address - Country:US
Mailing Address - Phone:952-892-7190
Mailing Address - Fax:952-892-7956
Practice Address - Street 1:675 E NICOLLET BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-6749
Practice Address - Country:US
Practice Address - Phone:952-892-7190
Practice Address - Fax:952-892-7956
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR128756-3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN151313OtherUCARE MN
MN0402338OtherMEDICA
MN1026134OtherPREFERREDONE
MN266901300Medicaid
WI41184000Medicaid
MNHP32384OtherHEALTHPARTNERS
MN66B61FUOtherBLUE CROSS BLUE SHIELD MN
MN1195483OtherAMERICA'S PPO
MN0402338OtherMEDICA
MN500001491Medicare ID - Type UnspecifiedMN MEDICARE