Provider Demographics
NPI:1801234257
Name:OGRINC-PAULUS, TERESE ANN (MLTASCT)
Entity type:Individual
Prefix:
First Name:TERESE
Middle Name:ANN
Last Name:OGRINC-PAULUS
Suffix:
Gender:F
Credentials:MLTASCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 H STREET EAST
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0067
Mailing Address - Country:US
Mailing Address - Phone:406-768-2172
Mailing Address - Fax:406-768-3435
Practice Address - Street 1:107 H STREET EAST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-0067
Practice Address - Country:US
Practice Address - Phone:406-768-2172
Practice Address - Fax:406-768-3435
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2200168Medicaid