Healthcare Provider Details

I. General information

NPI: 1114659349
Provider Name (Legal Business Name): PAIGE M MCELFRESH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE M PAVLIK APRN

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST STE 405
LINCOLN NE
68502-3793
US

IV. Provider business mailing address

PO BOX 860876
MINNEAPOLIS MN
55486-0876
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-5860
  • Fax:
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number114241
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114241
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: