Provider Demographics
NPI:1376515718
Name:PAGE, KAREN R (ARNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:R
Last Name:PAGE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N 9TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3909
Mailing Address - Country:US
Mailing Address - Phone:515-574-6890
Mailing Address - Fax:
Practice Address - Street 1:301 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAC CITY
Practice Address - State:IA
Practice Address - Zip Code:50583-2411
Practice Address - Country:US
Practice Address - Phone:712-662-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA068150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI7480Medicare PIN
P70332Medicare UPIN