Healthcare Provider Details

I. General information

NPI: 1639603285
Provider Name (Legal Business Name): PAIGE PAQUETTE HENNEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE PAQUETTE JENNINGS

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIR SUITE 2300
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIR SUITE 2300
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3630
  • Fax: 320-229-5142
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 5121
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: