Healthcare Provider Details

I. General information

NPI: 1528033966
Provider Name (Legal Business Name): REBECCA JOY PAIGE-GUERRA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 DIVISION AVE N
COMSTOCK PARK MI
49321-9546
US

IV. Provider business mailing address

5900 BYRON CENTER AVE SW MEDICAL ADMINISTRATION
WYOMING MI
49519-9606
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-1600
  • Fax: 616-252-1666
Mailing address:
  • Phone: 616-252-3243
  • Fax: 616-252-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601004546
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: