Healthcare Provider Details

I. General information

NPI: 1356068415
Provider Name (Legal Business Name): PAIGE PRITZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE MEDEARIS NP

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

IV. Provider business mailing address

401 ROXBURY RD
ROCKFORD IL
61107-5078
US

V. Phone/Fax

Practice location:
  • Phone: 815-397-7340
  • Fax:
Mailing address:
  • Phone: 815-397-7340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209026148
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: