Provider Demographics
NPI:1326712266
Name:VETRANO, PAIGE ALEXIS (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALEXIS
Last Name:VETRANO
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 1:180 CORLISS ST STE B
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2602
Mailing Address - Country:US
Mailing Address - Phone:401-793-8400
Mailing Address - Fax:401-793-8402
Practice Address - Street 1:180 CORLISS ST STE B
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2602
Practice Address - Country:US
Practice Address - Phone:401-793-8400
Practice Address - Fax:401-793-8402
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5338363A00000X
RIPA01393363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant