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General NPI Number Information
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NPI Number | 1083242663
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Entity Type | Individual
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Provider Name | MADDISEN PAYGE LONG-PERO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 1725 STATE STREET 4051 HEALTH SCIENCE CENTER
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City | LA CROSSE
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State | WI
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Zip | 54601
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Country | US
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Telephone | 608-785-5067
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 S STOUGHTON RD
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City | MADISON
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State | WI
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Zip | 53716-2257
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Country | US
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Telephone | 608-260-6000
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Fax | 608-260-6484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | 70111568
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5445
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License Number State | WI
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