Healthcare Provider Details

I. General information

NPI: 1619207925
Provider Name (Legal Business Name): MS. PATRICIA ANN HAYWARD PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

IV. Provider business mailing address

189 STORRS RD
MANSFIELD CENTER CT
06250-1683
US

V. Phone/Fax

Practice location:
  • Phone: 860-456-1311
  • Fax: 860-450-7623
Mailing address:
  • Phone: 860-456-1311
  • Fax: 860-450-7623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPTN0004865
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: