Healthcare Provider Details

I. General information

NPI: 1124391842
Provider Name (Legal Business Name): SARAH PAULSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD
MUNSTER IN
46321-2901
US

IV. Provider business mailing address

311 S COURT ST 101
CROWN POINT IN
46307-3934
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1600
  • Fax:
Mailing address:
  • Phone: 219-741-0548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28200086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: