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NPI Code Detail

MEDICARE: PAIGE AVERY FLICEK

MEDICARE: PAIGE AVERY FLICEK
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
1363L00000XNurse Practitioner11885MN

General Provider Information

NPI Number : 1457180580
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAIGE AVERY FLICEK
Provider Business Mailing Address
First Line : 3675 PHILLIPS PKWY APT 402
Second Line :
City : SAINT LOUIS PARK
State : MN
Zip : 55426-3775
Country : US
Telephone Number : 701-213-0663
Fax Number :
Provider Business Practice Location Address
First Line : 18465 ORCHARD TRL STE 320
Second Line :
City : LAKEVILLE
State : MN
Zip : 55044-2522
Country : US
Telephone Number : 612-871-1145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2024
Last Update Date : 07/29/2024

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Directions to “ PAIGE AVERY FLICEK ” Practice Location

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