Provider Demographics
NPI:1346697190
Name:WETTERN, PAIGE NICOLE (EDS)
Entity Type:Individual
Prefix:MRS
First Name:PAIGE
Middle Name:NICOLE
Last Name:WETTERN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E 2ND ST
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-2391
Mailing Address - Country:US
Mailing Address - Phone:605-528-3217
Mailing Address - Fax:605-528-3219
Practice Address - Street 1:705 E 2ND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-2391
Practice Address - Country:US
Practice Address - Phone:605-528-3217
Practice Address - Fax:605-528-3219
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD74457-0174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist