Provider Demographics
NPI:1831395649
Name:VAN PUL, PAULA G (MA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:G
Last Name:VAN PUL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 88747
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98498
Mailing Address - Country:US
Mailing Address - Phone:253-273-2342
Mailing Address - Fax:
Practice Address - Street 1:3815 100TH ST SW
Practice Address - Street 2:SUITE 2B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4401
Practice Address - Country:US
Practice Address - Phone:253-984-7686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006828171W00000X
WAFC00000207247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171W00000XOther Service ProvidersContractor
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other