Provider Demographics
NPI:1811197304
Name:PAIGE, PATTI M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:M
Last Name:PAIGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 10TH AVE S
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54534-1304
Mailing Address - Country:US
Mailing Address - Phone:715-561-3197
Mailing Address - Fax:906-358-4118
Practice Address - Street 1:E23570 CHOATE ROAD
Practice Address - Street 2:
Practice Address - City:WATERSMEET
Practice Address - State:MI
Practice Address - Zip Code:49969-0249
Practice Address - Country:US
Practice Address - Phone:906-358-4588
Practice Address - Fax:906-358-4118
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704142121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704142121OtherLICENCE NUMBER