MEDICARE: JENNIFER MICHELLE PAULSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363LF0000X	Family Nurse Practitioner	AP61400325	WA

General Provider Information

NPI Number	:	1891409090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MICHELLE PAULSEN

Provider Business Mailing Address
First Line	:	12522 E 24TH AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-2509
Country	:	US
Telephone Number	:	509-723-5391
Fax Number	:

Provider Business Practice Location Address
First Line	:	9827 N NEVADA ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99218-3407
Country	:	US
Telephone Number	:	509-468-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/25/2023

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Directions to “ JENNIFER MICHELLE PAULSEN ” Practice Location

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