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General NPI Number Information
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NPI Number | 1861228199
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Entity Type | Individual
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Provider Name | PAULETTE SIRUCEK RN, LPN
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Gender | Female
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 10640 92ND AVE SW
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City | MOTLEY
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State | MN
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Zip | 56466-2545
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Country | US
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Telephone | 218-640-6200
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Fax |
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Provider Business Mailing Address
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Address Line | 722 NW 7TH ST
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City | BRAINERD
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State | MN
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Zip | 56401-2912
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Country | US
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Telephone | 218-855-1115
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Fax | 218-855-1183
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2509877
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License Number State | MN
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