Healthcare Provider Details

I. General information

NPI: 1700204674
Provider Name (Legal Business Name): NATHANIEL PAULSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664
US

IV. Provider business mailing address

505 NE 87TH AVE STE 210
VANCOUVER WA
98664-1988
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-5396
  • Fax: 360-828-5455
Mailing address:
  • Phone: 360-828-5396
  • Fax: 360-828-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD-52667
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60815698
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: