Provider Demographics
NPI:1215574975
Name:PAIGE, CHANEA
Entity Type:Individual
Prefix:
First Name:CHANEA
Middle Name:
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 1:4702 PICKETT CT
Mailing Address - Street 2:
Mailing Address - City:MORNINGSIDE
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4631
Mailing Address - Country:US
Mailing Address - Phone:202-285-0379
Mailing Address - Fax:
Practice Address - Street 1:1753 A ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:301-775-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant