Mark Waynne Pauletich, RRT

Primary specialty

Critical Care Registered Respiratory TherapistTaxonomy code 2279C0205X

License

3645 Issued in MN

Practice address

N7, N12 & Fort Defiance
Fort Defiance, AZ 86504

Phone

(928) 729-8000

NPI assigned

Mar 24, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1659957058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9402 PRESERVE TRL",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551257501",
            "telephone_number": "715-529-6210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N7, N12 & FORT DEFIANCE",
            "city": "FORT DEFIANCE",
            "state": "AZ",
            "postal_code": "86504",
            "telephone_number": "928-729-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULETICH",
        "first_name": "MARK",
        "middle_name": "WAYNNE",
        "credential": "RRT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-24",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2279C0205X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Respiratory Therapist, Registered, Critical Care",
            "state": "MN",
            "license": "3645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juan C Pallares, M.D.
• Gilbert Palley, DO
• Hannah Christine Palm, M.D.
• Romulo Laureta Parungao, M.D.
• Maribel Pastran, RD, CD
• Tamara M. Peacock, RN
• Virginia Sheryl Pedersen, M.S. SLP-CCC
• Oscar Perera-Montanes, RPH, MBA
• Jimmy Perez, RRT
• Claude Clayton Perkins, MD

• Critical Care Registered Respiratory Therapist in Fort Defiance, AZ
• Providers in Fort Defiance, AZ by specialty
• Critical Care Registered Respiratory Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.