Provider Demographics
NPI:1477061133
Name:PAGE, MARYPAT (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MARYPAT
Middle Name:
Last Name:PAGE
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30000 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3429
Mailing Address - Country:US
Mailing Address - Phone:419-661-4001
Mailing Address - Fax:419-878-8515
Practice Address - Street 1:30000 E RIVER RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3429
Practice Address - Country:US
Practice Address - Phone:419-661-4001
Practice Address - Fax:419-661-4015
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP022190363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0261012Medicaid