Provider Demographics
NPI:1295627404
Name:EDENS, PAIGE ALYSSA
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:ALYSSA
Last Name:EDENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 RESERVE BLVD APT 314
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9156
Mailing Address - Country:US
Mailing Address - Phone:317-488-9227
Mailing Address - Fax:
Practice Address - Street 1:515 WALNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1621
Practice Address - Country:US
Practice Address - Phone:812-909-7234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program