MEDICARE: MRS. PAULINA JEAN RADEMAKER ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	3229P	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00283357	OTHER	KY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000388346	OTHER	KY	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366530826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAULINA JEAN RADEMAKER ARNP

Provider Business Mailing Address
First Line	:	8803 PETERBOROUGH DR
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-5221
Country	:	US
Telephone Number	:	502-749-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 BROWNS LN
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40220-1523
Country	:	US
Telephone Number	:	502-459-8900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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