Basic Information
| Provider Information | |||||||||
| NPI: | 1013986371 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAULSEN | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FULS | ||||||||
| OtherFirstName: | MICHELLE | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 675 E NICOLLET BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528927190 | ||||||||
| FaxNumber: | 9528927956 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 E NICOLLET BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553376749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528927190 | ||||||||
| FaxNumber: | 9528927956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 01/08/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R128756-3 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 151313 | 01 | MN | UCARE MN | OTHER | 0402338 | 01 | MN | MEDICA | OTHER | 1026134 | 01 | MN | PREFERREDONE | OTHER | 266901300 | 05 | MN | MEDICAID | 41184000 | 05 | WI | MEDICAID | HP32384 | 01 | MN | HEALTHPARTNERS | OTHER | 66B61FU | 01 | MN | BLUE CROSS BLUE SHIELD MN | OTHER | 1195483 | 01 | MN | AMERICA'S PPO | OTHER |