Provider Demographics
NPI:1033552302
Name:PAGE-PERREAULT, SHANNA M (LPN-IV)
Entity Type:Individual
Prefix:MS
First Name:SHANNA
Middle Name:M
Last Name:PAGE-PERREAULT
Suffix:
Gender:F
Credentials:LPN-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7056 STATE ROUTE 546
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44813-9316
Mailing Address - Country:US
Mailing Address - Phone:419-632-0595
Mailing Address - Fax:
Practice Address - Street 1:7056 STATE ROUTE 546
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:OH
Practice Address - Zip Code:44813-9316
Practice Address - Country:US
Practice Address - Phone:419-632-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN112544-IV164W00000X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse