Provider Demographics
NPI:1356794457
Name:KENDALL, PAIGE DERMER (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:DERMER
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MSM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3900
Practice Address - Street 1:901 E 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1175
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3901
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV25378207VC0300X, 207V00000X
CODR.0067964207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family Planning
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1356794457Medicaid