Provider Demographics
NPI:1922854413
Name:WILSON, PAIGE (MPH, RDN, LD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MPH, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 DUNLAVY ST APT 4304
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-1953
Mailing Address - Country:US
Mailing Address - Phone:713-798-7877
Mailing Address - Fax:
Practice Address - Street 1:7200 CAMBRIDGE ST FL 6
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-7877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT88687133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty