MEDICARE: MS. AIMEE ERIN PAULSON FNP-C

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	163W00000X	Registered Nurse	715799	CA
2	363LF0000X	Family Nurse Practitioner	17897	CA

General Provider Information

NPI Number	:	1740463611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AIMEE ERIN PAULSON FNP-C

Provider Business Mailing Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-594-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	4333 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4715
Country	:	US
Telephone Number	:	510-594-7400
Fax Number	:

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	11/06/2012

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