Provider Demographics
NPI:1235904970
Name:MORTIMER, PAIGE ERIN (APRN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ERIN
Last Name:MORTIMER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N CUSTER ST
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:KS
Mailing Address - Zip Code:67436-9284
Mailing Address - Country:US
Mailing Address - Phone:785-243-0821
Mailing Address - Fax:
Practice Address - Street 1:830 ELM ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:KS
Practice Address - Zip Code:67467-1608
Practice Address - Country:US
Practice Address - Phone:785-392-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS390200000X
KS53-82808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program