Provider Demographics
NPI:1609446988
Name:HEIM, PAIGE (APNP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:HEIM
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 INDEX RD
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53713-3117
Mailing Address - Country:US
Mailing Address - Phone:608-229-7979
Mailing Address - Fax:608-229-8110
Practice Address - Street 1:2844 INDEX RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53713-3117
Practice Address - Country:US
Practice Address - Phone:608-229-7979
Practice Address - Fax:608-229-8110
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11199363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1609446988Medicaid