Healthcare Provider Details

I. General information

NPI: 1285302455
Provider Name (Legal Business Name): PAIGE DEWANE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 S 27TH ST
MILWAUKEE WI
53215-4338
US

IV. Provider business mailing address

455 E PLEASANT ST APT 409
MILWAUKEE WI
53202-2692
US

V. Phone/Fax

Practice location:
  • Phone: 146-728-2824
  • Fax: 414-672-8284
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number24696730
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16612-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: