Provider Demographics
NPI:1285824342
Name:PAGE, CARRIE LYNN (MS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:PAGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6061 S. FORT APACHE
Mailing Address - Street 2:STE. 130
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-990-1568
Mailing Address - Fax:702-943-1804
Practice Address - Street 1:6061 S. FORT APACHE
Practice Address - Street 2:STE. 130
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-990-1568
Practice Address - Fax:702-943-1804
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV289237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509028Medicaid