Provider Demographics
NPI:1730711649
Name:PAULSON, DIANE LOUISE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:LOUISE
Last Name:PAULSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 NE 41ST ST STE 206
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6778
Mailing Address - Country:US
Mailing Address - Phone:360-258-1838
Mailing Address - Fax:206-339-5739
Practice Address - Street 1:7200 NE 41ST ST STE 206
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6778
Practice Address - Country:US
Practice Address - Phone:360-258-1838
Practice Address - Fax:206-339-5739
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00107018163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development