Provider Demographics
NPI:1023201738
Name:PAGE, MARSHA JEANETTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:JEANETTE
Last Name:PAGE
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:PO BOX 27302
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7302
Mailing Address - Country:US
Mailing Address - Phone:517-285-6193
Mailing Address - Fax:517-393-5547
Practice Address - Street 1:2400 ROBINSON RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-4860
Practice Address - Country:US
Practice Address - Phone:517-285-6193
Practice Address - Fax:517-393-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-26
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703061419164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10 0004361092Medicaid