Individual
JONATHAN NIS PAULSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 577-8000
Mailing address
4049 W PINE BLVD, APT 101, SAINT LOUIS, MO 63108-3258
(925) 451-6930
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2019042333
MO
207P00000X
Emergency Medicine Physician
Primary
A161512
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2016
Last updated
11/27/2019
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