Provider Demographics
NPI:1184403925
Name:PAUL, KATTRINA R (LM, CPM)
Entity type:Individual
Prefix:
First Name:KATTRINA
Middle Name:R
Last Name:PAUL
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9933 BLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49053-9598
Mailing Address - Country:US
Mailing Address - Phone:989-709-0954
Mailing Address - Fax:989-709-0954
Practice Address - Street 1:9933 BLAKE BLVD
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:MI
Practice Address - Zip Code:49053-9598
Practice Address - Country:US
Practice Address - Phone:989-709-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000124176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife