Healthcare Provider Details

I. General information

NPI: 1235881962
Provider Name (Legal Business Name): PAIGE RENEE ANDERSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PRESTON ST
RANSON WV
25438-1631
US

IV. Provider business mailing address

210 SYMINGTON DR
MARTINSBURG WV
25404-2685
US

V. Phone/Fax

Practice location:
  • Phone: 304-728-1600
  • Fax:
Mailing address:
  • Phone: 717-360-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111241
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: