Provider Demographics
NPI:1215461207
Name:WADDELL, PAIGE MARIE (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:WADDELL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207D COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2363
Mailing Address - Country:US
Mailing Address - Phone:740-376-0930
Mailing Address - Fax:304-295-3345
Practice Address - Street 1:207D COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2363
Practice Address - Country:US
Practice Address - Phone:740-376-0930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily