Provider Demographics
NPI:1891187431
Name:PAETZ, MARGARET FAYE (CPNP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:FAYE
Last Name:PAETZ
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 HIGHWAY 614 # B
Mailing Address - Street 2:
Mailing Address - City:MOSS POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39562-7569
Mailing Address - Country:US
Mailing Address - Phone:228-273-0400
Mailing Address - Fax:228-333-0759
Practice Address - Street 1:5605 HIGHWAY 614 # B
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-7569
Practice Address - Country:US
Practice Address - Phone:228-273-0400
Practice Address - Fax:228-333-0759
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865490363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics