Provider Demographics
NPI:1033792262
Name:PAGE, MICHELE LUCETTE (RN(REGISTERED NURSE))
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LUCETTE
Last Name:PAGE
Suffix:
Gender:F
Credentials:RN(REGISTERED NURSE)
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:LUCETTE
Other - Last Name:ENOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:541 PENNY LANE
Mailing Address - Street 2:
Mailing Address - City:USK
Mailing Address - State:WA
Mailing Address - Zip Code:99180-9732
Mailing Address - Country:US
Mailing Address - Phone:509-445-1060
Mailing Address - Fax:
Practice Address - Street 1:541 PENNY LANE
Practice Address - Street 2:
Practice Address - City:USK
Practice Address - State:WA
Practice Address - Zip Code:99180-9732
Practice Address - Country:US
Practice Address - Phone:509-445-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60160162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse