1912247230 NPI number — MRS. KELLI MARIE PAULUS HBCE, PES

Table of content: MRS. KELLI MARIE PAULUS HBCE, PES (NPI 1912247230)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912247230 NPI number — MRS. KELLI MARIE PAULUS HBCE, PES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAULUS
Provider First Name:
KELLI
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
HBCE, PES
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912247230
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
480 SAINT MORITZ DR
Provider Second Line Business Mailing Address:
UNIT 1B
Provider Business Mailing Address City Name:
GLEN ELLYN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60137-4353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-603-3530
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
480 SAINT MORITZ DR
Provider Second Line Business Practice Location Address:
UNIT 1B
Provider Business Practice Location Address City Name:
GLEN ELLYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60137-4353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-603-3530
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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