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General NPI Number Information
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NPI Number | 1821723123
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Entity Type | Individual
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Provider Name | PAIGE ELIZABETH REESER NP
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Gender | Female
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Dates
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Enumeration Date | 07/20/2022
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Last Update Date | 07/20/2022
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Provider Practice Location Address
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Address Line | 110 N BURR BLVD
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City | KEWANEE
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State | IL
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Zip | 61443-2214
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Country | US
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Telephone | 309-852-0197
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Fax |
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Provider Business Mailing Address
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Address Line | 10809 E 2720 ST
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City | KEWANEE
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State | IL
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Zip | 61443-8691
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Country | US
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Telephone | 309-854-1075
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209025506
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License Number State | IL
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