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General NPI Number Information
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NPI Number | 1841074564
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Entity Type | Individual
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Provider Name | PAIGE GUIBOURDANCHE
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Gender | Female
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 18 N COUNTY ST FL 7
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City | WAUKEGAN
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State | IL
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Zip | 60085-4304
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Country | US
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Telephone | 847-377-2322
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 BAGATELLE LN
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City | MUNDELEIN
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State | IL
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Zip | 60060-6001
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Country | US
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Telephone | 847-530-2888
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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