Provider Demographics
NPI:1750830105
Name:MCKINNON, PAULA (DNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:MCKINNON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:9576 HWY 70
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9067
Mailing Address - Country:US
Mailing Address - Phone:715-358-1800
Mailing Address - Fax:715-358-1041
Practice Address - Street 1:9576 HWY 70
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9067
Practice Address - Country:US
Practice Address - Phone:715-358-1800
Practice Address - Fax:715-358-1041
Is Sole Proprietor?:No
Enumeration Date:2016-09-27
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7307-33363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner