Individual
MADDISEN PAYGE LONG-PERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1725 STATE STREET, 4051 HEALTH SCIENCE CENTER, LA CROSSE, WI 54601
(608) 785-5067
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6484
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
70111568
WI
363A00000X
Physician Assistant
Primary
5445
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083242663
—
WI
Enumeration date
03/30/2020
Last updated
07/19/2021
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