Healthcare Provider Details

I. General information

NPI: 1659698306
Provider Name (Legal Business Name): PAIGE JOSEPHINE HALVORSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE JOSEPHINE WALTER M. D.

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WABASHA ST S
SAINT PAUL MN
55107-1805
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
MINNEAPOLIS MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-293-8100
  • Fax: 651-293-8106
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number62374
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: