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NPI Code Detail

MEDICARE: PAIGE PATTILLO NP

MEDICARE: PAIGE PATTILLO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner201601264NP-PPOR
2363LF0000XFamily Nurse Practitioner1-054204AL
3363LF0000XFamily Nurse Practitioner201601264NP-PPOR
4363LP2300XPrimary Care Nurse Practitioner1-054204AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1201601263RNOTHEROROREGON STATE BOARD OF NURSING
2201602164NP-PPOTHEROROREGON STATE BOARD OF NURSING

General Provider Information

NPI Number : 1083091029
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE PATTILLO NP
Provider Business Mailing Address
First Line : PO BOX 118
Second Line :
City : STAYTON
State : OR
Zip : 97383-0118
Country : US
Telephone Number : 503-507-5356
Fax Number : 866-225-2708
Provider Business Practice Location Address
First Line : 41805 STAYTON SCIO RD SE
Second Line :
City : STAYTON
State : OR
Zip : 97383-9739
Country : US
Telephone Number : 503-507-5356
Fax Number : 866-225-2708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2015
Last Update Date : 12/27/2025

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