Provider Demographics
NPI:1194895888
Name:DEARHOLT, PAULA C (RN, WHCNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:C
Last Name:DEARHOLT
Suffix:
Gender:F
Credentials:RN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7575
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:671 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1312
Practice Address - Country:US
Practice Address - Phone:218-368-2798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR124952-7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
122972OtherUCARE PROVIDER ID
HP26447OtherHEALTH PARTNERS PROV ID
MN666420200Medicaid
1068173OtherAMERICA'S PPO PROV ID
29076OtherSIOUX VALLEY PROV ID
1016947OtherPREFERRED ONE PROV ID
68G08DEOtherBCBS MN PROVIDER ID
07-00637OtherMEDICA PROVIDER ID
29076OtherSIOUX VALLEY PROV ID
1068173OtherAMERICA'S PPO PROV ID
07-00637OtherMEDICA PROVIDER ID