Provider Demographics
NPI:1003420100
Name:STANZEL, PAIGE (PA)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:
Last Name:STANZEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NE
Mailing Address - Zip Code:68069-2212
Mailing Address - Country:US
Mailing Address - Phone:402-658-3150
Mailing Address - Fax:
Practice Address - Street 1:610 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NE
Practice Address - Zip Code:68069-2212
Practice Address - Country:US
Practice Address - Phone:402-658-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2524OtherPHYSICIAN ASSISTANT STATE LICENSE