Individual
JENICA MYREA PAULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.T.C.
Contact information
Practice address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
(417) 836-5461
Mailing address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
(417) 836-5461
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2014022273
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649341272
FACILITY NPI NUMBER
MO
Enumeration date
07/29/2014
Last updated
07/29/2014
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