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General NPI Number Information
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NPI Number | 1528217114
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Entity Type | Individual
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Provider Name | HEIDI PAULSEN RD, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 14593 WINDWAY DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-7677
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Country | US
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Telephone | 636-345-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 14593 WINDWAY DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-7677
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Country | US
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Telephone | 636-345-2375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2012018842
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2005010724
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License Number State | MO
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