Provider Demographics
NPI:1629570247
Name:NIELSON, PAIGE M (RN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:M
Last Name:NIELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:M
Other - Last Name:IMMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:261 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:PESHTIGO
Mailing Address - State:WI
Mailing Address - Zip Code:54157-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 BITTERS AVE
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-2074
Practice Address - Country:US
Practice Address - Phone:715-923-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321273163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health