Healthcare Provider Details

I. General information

NPI: 1689477036
Provider Name (Legal Business Name): ANDREA PAULLUS RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WOODLAND DR
COOS BAY OR
97420-2045
US

IV. Provider business mailing address

2195 LOMBARD ST
NORTH BEND OR
97459-1450
US

V. Phone/Fax

Practice location:
  • Phone: 541-267-5151
  • Fax:
Mailing address:
  • Phone: 541-260-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number201242497RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: