Provider Demographics
NPI:1720330517
Name:PAULSON, TRICIA (ND)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:PAULSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CHIEFTAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSCEOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54020-8016
Mailing Address - Country:US
Mailing Address - Phone:715-755-2552
Mailing Address - Fax:
Practice Address - Street 1:708 CHIEFTAIN ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:WI
Practice Address - Zip Code:54020-8016
Practice Address - Country:US
Practice Address - Phone:715-755-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1029175F00000X, 133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No133N00000XDietary & Nutritional Service ProvidersNutritionist