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General NPI Number Information
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NPI Number | 1689876823
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Entity Type | Individual
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Provider Name | MICHELLE MARIE PAULSEN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 06/24/2010
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Provider Practice Location Address
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Address Line | 516 INNOVATION DR SUITE 103
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3847
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Country | US
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Telephone | 757-495-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 609 CENTERVILLE TPKE S
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City | CHESAPEAKE
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State | VA
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Zip | 23322-3913
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Country | US
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Telephone | 757-621-6424
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0102201919
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License Number State | VA
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