Provider Demographics
NPI:1992744569
Name:ANDERSON, PAULA KAE (ARNP)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:KAE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAE
Other - Last Name:BAHNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:IA
Mailing Address - Zip Code:50625-0463
Mailing Address - Country:US
Mailing Address - Phone:641-857-3523
Mailing Address - Fax:
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA073076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q35839Medicare UPIN