Individual
PAIGE DETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
901 3RD ST N, WAITE PARK, MN 56387-1964
(320) 217-8480
Mailing address
901 3RD ST N, WAITE PARK, MN 56387-1964
(320) 352-8475
(320) 217-8490
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1160996
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009-0918346
MEDICA
MN
Enumeration date
09/09/2019
Last updated
06/01/2020
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