Provider Demographics
NPI:1477167864
Name:REZENDES, PAIGE NICHOLE (RN, CCRN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICHOLE
Last Name:REZENDES
Suffix:
Gender:F
Credentials:RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 N 185TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2691
Mailing Address - Country:US
Mailing Address - Phone:623-687-8952
Mailing Address - Fax:
Practice Address - Street 1:4842 N 185TH DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2691
Practice Address - Country:US
Practice Address - Phone:623-687-8952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN208504163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine