Provider Demographics
NPI:1699412619
Name:HANRECK, PAIGE AMBERLY (PA)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:AMBERLY
Last Name:HANRECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:ZACHRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24075 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5823
Mailing Address - Country:US
Mailing Address - Phone:216-831-5700
Mailing Address - Fax:
Practice Address - Street 1:24075 COMMERCE PARK
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5823
Practice Address - Country:US
Practice Address - Phone:216-831-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007898RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant