=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164875720
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAIGE ALEXANDRA HELM NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2016
-----------------------------------------------------
Last Update Date | 10/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 S CHERRY AVE UNIT 1
-----------------------------------------------------
City | EATON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80615-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-454-3838
-----------------------------------------------------
Fax | 970-454-1265
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 S CHERRY AVE UNIT 1
-----------------------------------------------------
City | EATON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80615-8256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-454-3838
-----------------------------------------------------
Fax | 970-454-1265
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R36815
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------