Provider Demographics
NPI:1881110542
Name:PACHUCKI, PAIGE ELIZABETH (CNA)
Entity type:Individual
Prefix:MISS
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:PACHUCKI
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23026 E RYER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61531-9329
Mailing Address - Country:US
Mailing Address - Phone:563-506-4790
Mailing Address - Fax:
Practice Address - Street 1:23026 E RYER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61531-9329
Practice Address - Country:US
Practice Address - Phone:563-506-4790
Practice Address - Fax:563-506-4790
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility