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General NPI Number Information
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NPI Number | 1659646115
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Entity Type | Individual
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Provider Name | KELLY GARNESKI PAULSON MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2012
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 21632 HIGHWAY 99
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City | EDMONDS
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State | WA
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Zip | 98026
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Country | US
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Telephone | 425-775-1677
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Fax | 425-778-1635
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Provider Business Mailing Address
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Address Line | 800 5TH AVE STE 600
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City | SEATTLE
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State | WA
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Zip | 98104-3186
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Country | US
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Telephone | 425-775-1677
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Fax | 425-778-1635
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | MD60494102
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License Number State | WA
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