Provider Demographics
NPI:1588107221
Name:ORTIZ, PAIGE JUNE (ARNP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:JUNE
Last Name:ORTIZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:JUNE
Other - Last Name:POTTEBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1000 LANGWORTHY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-7365
Mailing Address - Country:US
Mailing Address - Phone:563-584-3425
Mailing Address - Fax:563-584-3497
Practice Address - Street 1:1000 LANGWORTHY ST STE 100
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-7365
Practice Address - Country:US
Practice Address - Phone:563-584-3425
Practice Address - Fax:563-584-3497
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA112603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily