Provider Demographics
NPI:1528822533
Name:BARTUCH, PAIGE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:BARTUCH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 BELSON LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6589
Mailing Address - Country:US
Mailing Address - Phone:847-845-1261
Mailing Address - Fax:
Practice Address - Street 1:39 N WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4403
Practice Address - Country:US
Practice Address - Phone:815-893-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily