Provider Demographics
NPI:1821723123
Name:REESER, PAIGE ELIZABETH (NP)
Entity Type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:REESER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10809 E 2720 ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-8691
Mailing Address - Country:US
Mailing Address - Phone:309-854-1075
Mailing Address - Fax:
Practice Address - Street 1:110 N BURR BLVD
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-2214
Practice Address - Country:US
Practice Address - Phone:309-852-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025506363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health