Provider Demographics
NPI:1316544265
Name:PAGE, MALARI (LPN)
Entity Type:Individual
Prefix:
First Name:MALARI
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ALADDIN CIR APT 6
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4376
Mailing Address - Country:US
Mailing Address - Phone:978-902-5101
Mailing Address - Fax:
Practice Address - Street 1:2 ALADDIN CIR APT 6
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-4376
Practice Address - Country:US
Practice Address - Phone:978-902-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH017925-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse