Provider Demographics
NPI:1649329095
Name:PAULSEN, SUSAN (RNFA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:PAULSEN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COFFEE RD
Mailing Address - Street 2:C-3
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
Mailing Address - Country:US
Mailing Address - Phone:209-529-0527
Mailing Address - Fax:209-529-6610
Practice Address - Street 1:817 COFFEE RD
Practice Address - Street 2:C-3
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-529-0527
Practice Address - Fax:209-529-6610
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN320800282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital