Healthcare Provider Details

I. General information

NPI: 1730775966
Provider Name (Legal Business Name): PAIGE BRENNAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE LAY

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 1ST ST
LA SALLE IL
61301-2537
US

IV. Provider business mailing address

917 1ST ST
LA SALLE IL
61301-2537
US

V. Phone/Fax

Practice location:
  • Phone: 815-780-2525
  • Fax: 815-205-4533
Mailing address:
  • Phone: 815-780-2525
  • Fax: 815-205-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277004726
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: