Provider Demographics
NPI:1538426424
Name:COUSINEAU, PAULINE S
Entity type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:S
Last Name:COUSINEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:PAULINE
Other - Middle Name:K
Other - Last Name:SPAETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:111 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN UNIVERSITY
Mailing Address - State:PA
Mailing Address - Zip Code:19352-1120
Mailing Address - Country:US
Mailing Address - Phone:610-999-9441
Mailing Address - Fax:
Practice Address - Street 1:1011 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9446
Practice Address - Country:US
Practice Address - Phone:610-869-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012053363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health