Healthcare Provider Details

I. General information

NPI: 1013613793
Provider Name (Legal Business Name): PAIGE JOLYNN STODTMEISTER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 WASHINGTON ST
NEWTON MA
02462-1699
US

IV. Provider business mailing address

10693 S VERMILLION DR
SOUTH JORDAN UT
84009-5726
US

V. Phone/Fax

Practice location:
  • Phone: 617-243-6000
  • Fax:
Mailing address:
  • Phone: 801-891-6457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2390677
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: