Provider Demographics
NPI:1477274264
Name:PAGE, EMILY VIRGINIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:VIRGINIA
Last Name:PAGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3158 FREEDOM DR STE 3102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-0014
Mailing Address - Country:US
Mailing Address - Phone:704-332-0396
Mailing Address - Fax:
Practice Address - Street 1:3033 EASTWAY DR STE 201
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6387
Practice Address - Country:US
Practice Address - Phone:704-731-6451
Practice Address - Fax:704-731-6452
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5016887363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner