Provider Demographics
NPI:1730193442
Name:HYSER, CHRISTINA RAE PAULSEN (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RAE PAULSEN
Last Name:HYSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11134 N STATE ROAD 77
Mailing Address - Street 2:DULUTH CLINIC HAYWARD
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843
Mailing Address - Country:US
Mailing Address - Phone:715-634-5505
Mailing Address - Fax:
Practice Address - Street 1:1885 PLAZA DR
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2979
Practice Address - Country:US
Practice Address - Phone:952-993-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51958-20207Q00000X
MN48645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN754473000Medicaid
P00438369OtherRR MEDICARE PTAN
MN153H4PAOtherBCBSMN
MN01-25342OtherMEDICA
P00438369OtherRR MEDICARE PTAN
MN080015225Medicare ID - Type Unspecified