Provider Demographics
NPI:1265680151
Name:PAGET, GAYE LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:GAYE
Middle Name:LYNN
Last Name:PAGET
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 1:815 W BROADWAY ST # U
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-2215
Mailing Address - Country:US
Mailing Address - Phone:330-635-9268
Mailing Address - Fax:
Practice Address - Street 1:411 W BROADWAY ST
Practice Address - Street 2:SUITE C
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-2446
Practice Address - Country:US
Practice Address - Phone:989-317-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001966363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700H231390OtherBCBS GROUP NUMBER
MI0P47270Medicare PIN