MEDICARE: NATHANIEL PAULSON M.D.

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	207L00000X	Anesthesiology Physician	MD-52667	IA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207L00000X	Anesthesiology Physician	MD60815698	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700204674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL PAULSON M.D.

Provider Business Mailing Address
First Line	:	505 NE 87TH AVE STE 210
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-1988
Country	:	US
Telephone Number	:	360-828-5396
Fax Number	:	360-828-5455

Provider Business Practice Location Address
First Line	:	400 NE MOTHER JOSEPH PL
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664
Country	:	US
Telephone Number	:	360-828-5396
Fax Number	:	360-828-5455

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

Provider Enumeration Date	:	03/28/2014
Last Update Date	:	12/11/2025

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