Provider Demographics
NPI:1841074564
Name:GUIBOURDANCHE, PAIGE
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:GUIBOURDANCHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 BAGATELLE LN
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-6001
Mailing Address - Country:US
Mailing Address - Phone:847-530-2888
Mailing Address - Fax:
Practice Address - Street 1:18 N COUNTY ST FL 7
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4304
Practice Address - Country:US
Practice Address - Phone:847-377-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist