Provider Demographics
NPI:1003056466
Name:SAGE, ANNA TERESE (LPN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:TERESE
Last Name:SAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10102 RANSOM RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9604
Mailing Address - Country:US
Mailing Address - Phone:419-359-1257
Mailing Address - Fax:
Practice Address - Street 1:10102 RANSOM RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44847-9604
Practice Address - Country:US
Practice Address - Phone:419-359-1257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 111275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse