Healthcare Provider Details

I. General information

NPI: 1740118272
Provider Name (Legal Business Name): PAIGE ELISABETH SIDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 QUEEN ST
WINSTON SALEM NC
27103-2628
US

IV. Provider business mailing address

722 PLAYERS RIDGE RD
HICKORY NC
28601-8858
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2011
  • Fax:
Mailing address:
  • Phone: 386-262-4984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: