Healthcare Provider Details

I. General information

NPI: 1376242594
Provider Name (Legal Business Name): PAIGE ROSELEN HANKINS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAIGE ROSELEN BUELOW

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3283 WILLOWCREEK RD
PORTAGE IN
46368-5054
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-764-8439
  • Fax: 219-764-8463
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28261517A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013693A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: