Healthcare Provider Details

I. General information

NPI: 1710137864
Provider Name (Legal Business Name): TIFFANY MARIE PAULSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 W OAKEY BLVD
LAS VEGAS NV
89102-1535
US

IV. Provider business mailing address

4750 W OAKEY BLVD
LAS VEGAS NV
89102-1535
US

V. Phone/Fax

Practice location:
  • Phone: 702-877-5199
  • Fax:
Mailing address:
  • Phone: 702-877-5199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number63670
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: