MEDICARE: PAIGE WEISZ APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	323736	AZ

General Provider Information

NPI Number	:	1396536413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE WEISZ APRN

Provider Business Mailing Address
First Line	:	5601 S GAZELLE DR
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9292
Country	:	US
Telephone Number	:	928-201-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 CIVIC CENTER LN
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403
Country	:	US
Telephone Number	:	928-201-7243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2025
Last Update Date	:	05/18/2026

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