Provider Demographics
NPI:1003697095
Name:PACHECO, PAIGE KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:KAY
Last Name:PACHECO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1946
Mailing Address - Country:US
Mailing Address - Phone:144-363-6120
Mailing Address - Fax:
Practice Address - Street 1:5851 W 95TH ST STE 300
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2415
Practice Address - Country:US
Practice Address - Phone:708-499-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant