Healthcare Provider Details

I. General information

NPI: 1619885092
Provider Name (Legal Business Name): PAIGE ALEXANDRIA DYLEWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N MAIN ST
ROANOKE IL
61561-7585
US

IV. Provider business mailing address

2500 W REYNOLDS ST
PONTIAC IL
61764-9784
US

V. Phone/Fax

Practice location:
  • Phone: 309-923-2661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209036503
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036503
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: