Healthcare Provider Details

I. General information

NPI: 1619838067
Provider Name (Legal Business Name): PAIGE EMMA FELLOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

531 SHADETREE BLVD
MARIETTA PA
17547-8555
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax:
Mailing address:
  • Phone: 570-573-7746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: