Healthcare Provider Details

I. General information

NPI: 1699031419
Provider Name (Legal Business Name): HAILEY ELIZABETH PAIGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAILEY ELIZABETH ROBERTS

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 PLEASANT ST STE G100
CONCORD NH
03301-2588
US

IV. Provider business mailing address

248 PLEASANT ST STE G100
CONCORD NH
03301-2588
US

V. Phone/Fax

Practice location:
  • Phone: 603-230-1970
  • Fax: 603-227-7573
Mailing address:
  • Phone: 603-230-1970
  • Fax: 603-227-7573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0888
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: