Provider Demographics
NPI:1598327884
Name:HUNTSMAN, PAIGE LAUREL (CAPA064)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:LAUREL
Last Name:HUNTSMAN
Suffix:
Gender:F
Credentials:CAPA064
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GREAT PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:ARAPAHOE
Mailing Address - State:WY
Mailing Address - Zip Code:82510
Mailing Address - Country:US
Mailing Address - Phone:307-856-0470
Mailing Address - Fax:307-463-4254
Practice Address - Street 1:24 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-856-0470
Practice Address - Fax:307-463-4254
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker