Provider Demographics
NPI:1639987555
Name:ELLSWORTH, PAIGE (NP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:ELLSWORTH
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 1:2221 W PECOS RD STE 6
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4803
Mailing Address - Country:US
Mailing Address - Phone:480-808-8869
Mailing Address - Fax:
Practice Address - Street 1:2221 W PECOS RD STE 6
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4803
Practice Address - Country:US
Practice Address - Phone:480-808-8869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ269281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily