Basic Information
Provider Information
NPI: 1588958490
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAULSEN
FirstName: MEGAN
MiddleName: ELIZABETH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: GOSLING
OtherFirstName: MEGAN
OtherMiddleName: ELIZABETH
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 1
Mailing Information
Address1: 2512 S 7TH ST
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554541404
CountryCode: US
TelephoneNumber: 6123656777
FaxNumber:  
Practice Location
Address1: 2512 S 7TH ST
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554541404
CountryCode: US
TelephoneNumber: 6123656777
FaxNumber: 6123658001
Other Information
ProviderEnumerationDate: 06/08/2011
LastUpdateDate: 04/11/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X62351MNY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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