Provider Demographics
NPI:1245911999
Name:MABERRY, PAIGE LEE (PA-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:LEE
Last Name:MABERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 FRONTIER RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-7747
Mailing Address - Country:US
Mailing Address - Phone:530-906-9431
Mailing Address - Fax:
Practice Address - Street 1:2515 FRONTIER RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-7747
Practice Address - Country:US
Practice Address - Phone:530-906-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA62774363A00000X
WAPA.PA.61435763363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant