Provider Demographics
NPI:1437497476
Name:PAGE, TONYA (LPN)
Entity Type:Individual
Prefix:
First Name:TONYA
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 1:1833 HOLIDAY HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37166-7360
Mailing Address - Country:US
Mailing Address - Phone:931-303-1923
Mailing Address - Fax:
Practice Address - Street 1:1101 NEAL ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0901
Practice Address - Country:US
Practice Address - Phone:931-528-8593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77317164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN77317OtherLPN LICENSE