Provider Demographics
NPI:1962155069
Name:PATURALSKI, AUSTA
Entity type:Individual
Prefix:
First Name:AUSTA
Middle Name:
Last Name:PATURALSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 RUNAWAY BAY CIR APT 2A
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-8068
Mailing Address - Country:US
Mailing Address - Phone:574-229-0847
Mailing Address - Fax:
Practice Address - Street 1:325 RUNAWAY BAY CIR APT 2A
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8068
Practice Address - Country:US
Practice Address - Phone:574-229-0847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician