Healthcare Provider Details

I. General information

NPI: 1366530826
Provider Name (Legal Business Name): PAULINA JEAN RADEMAKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BROWNS LN
LOUISVILLE KY
40220-1523
US

IV. Provider business mailing address

8803 PETERBOROUGH DR
LOUISVILLE KY
40222-5221
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-8900
  • Fax:
Mailing address:
  • Phone: 502-749-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3229P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: