Basic Information
| Provider Information | |||||||||
| NPI: | 1811197304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAIGE | ||||||||
| FirstName: | PATTI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 10TH AVE S | ||||||||
| Address2: | |||||||||
| City: | HURLEY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545341304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155613197 | ||||||||
| FaxNumber: | 9063584118 | ||||||||
| Practice Location | |||||||||
| Address1: | E23570 CHOATE ROAD | ||||||||
| Address2: | |||||||||
| City: | WATERSMEET | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499690249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063584588 | ||||||||
| FaxNumber: | 9063584118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/23/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704142121 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 4704142121 | 01 | MI | LICENCE NUMBER | OTHER |