Provider Demographics
NPI:1215338355
Name:FORTIN, PAULA (FNP-C)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:FORTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:DAHLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:7650 CURRELL BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8209
Mailing Address - Country:US
Mailing Address - Phone:651-738-7800
Mailing Address - Fax:
Practice Address - Street 1:7650 CURRELL BLVD STE 330
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8209
Practice Address - Country:US
Practice Address - Phone:651-738-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1463363LF0000X
MN4481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily