Healthcare Provider Details

I. General information

NPI: 1235904970
Provider Name (Legal Business Name): PAIGE ERIN MORTIMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ELM ST
MINNEAPOLIS KS
67467-1608
US

IV. Provider business mailing address

830 ELM ST
MINNEAPOLIS KS
67467-1608
US

V. Phone/Fax

Practice location:
  • Phone: 785-392-2144
  • Fax:
Mailing address:
  • Phone: 785-392-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82808
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: