Provider Demographics
NPI:1194045401
Name:PAGE, CYNTHIA EILEEN (LPN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:EILEEN
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:EILEEN
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:432 140TH ST
Mailing Address - Street 2:
Mailing Address - City:SHERBURN
Mailing Address - State:MN
Mailing Address - Zip Code:56171-1140
Mailing Address - Country:US
Mailing Address - Phone:507-215-1092
Mailing Address - Fax:
Practice Address - Street 1:106 4TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1034
Practice Address - Country:US
Practice Address - Phone:218-998-3778
Practice Address - Fax:218-998-3187
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL36330-7164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse