Provider Demographics
NPI:1497730436
Name:PAGE, DIANE E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:PAGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 GREEN MOUNTAIN CIR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2434
Mailing Address - Country:US
Mailing Address - Phone:410-303-1228
Mailing Address - Fax:
Practice Address - Street 1:5011 GREEN MOUNTAIN CIR UNIT 1
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2434
Practice Address - Country:US
Practice Address - Phone:410-303-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164969363A00000X, 163W00000X
FLARNP9401308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK563M403Medicare PIN
FLIL881ZMedicare PIN