Provider Demographics
NPI:1740630797
Name:PAULUS, WILLIAM (RN)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:PAULUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 SE TENINO ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6756
Mailing Address - Country:US
Mailing Address - Phone:541-514-0699
Mailing Address - Fax:
Practice Address - Street 1:29757 SW BOONES FERRY RD
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-7202
Practice Address - Country:US
Practice Address - Phone:503-582-9246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201142463RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health