Provider Demographics
NPI:1649756875
Name:WAMPLER, PAIGE D (APRN-FNP-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:D
Last Name:WAMPLER
Suffix:
Gender:F
Credentials:APRN-FNP-C
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:D
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:727 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:IL
Mailing Address - Zip Code:61944-2460
Mailing Address - Country:US
Mailing Address - Phone:217-465-4141
Mailing Address - Fax:217-463-3184
Practice Address - Street 1:1 PHIPPS LANE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-2460
Practice Address - Country:US
Practice Address - Phone:217-463-4340
Practice Address - Fax:217-463-4342
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-11-21
Deactivation Date:2018-07-11
Deactivation Code:
Reactivation Date:2018-10-18
Provider Licenses
StateLicense IDTaxonomies
IL209018020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily