Provider Demographics
NPI:1205033966
Name:PAIGE, DEBRA LYNN
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:LYNN
Last Name:PAIGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 MONROE AVE
Mailing Address - Street 2:APT 31
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1074
Mailing Address - Country:US
Mailing Address - Phone:585-406-1630
Mailing Address - Fax:
Practice Address - Street 1:65 ROUND TRAIL DR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3249
Practice Address - Country:US
Practice Address - Phone:585-586-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286772-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02851283Medicaid