Provider Demographics
NPI:1518158831
Name:PAGEAU, MARY JANE (NP)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:PAGEAU
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 CADILLAC AVE
Mailing Address - Street 2:BLDG O, SUITE 110
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1429
Mailing Address - Country:US
Mailing Address - Phone:714-979-5680
Mailing Address - Fax:
Practice Address - Street 1:3505 CADILLAC AVE
Practice Address - Street 2:BLDG O, SUITE 110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1429
Practice Address - Country:US
Practice Address - Phone:714-979-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506730363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner