1598163958 NPI number — PAIGE FAYE EGGERS BSN, RN, GRNA

Table of content: PAIGE FAYE EGGERS BSN, RN, GRNA (NPI 1598163958)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598163958 NPI number — PAIGE FAYE EGGERS BSN, RN, GRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EGGERS
Provider First Name:
PAIGE
Provider Middle Name:
FAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, GRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598163958
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MALLARD CREEK RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-473-2132
Provider Business Mailing Address Fax Number:
502-459-0923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MALLARD CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-473-2132
Provider Business Practice Location Address Fax Number:
502-459-0923
Provider Enumeration Date:
12/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  1120529 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: 3009216 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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