Provider Demographics
NPI:1558969493
Name:CHILDS, CESCELLI PAIGE (LPN)
Entity Type:Individual
Prefix:
First Name:CESCELLI
Middle Name:PAIGE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-2703
Mailing Address - Country:US
Mailing Address - Phone:618-802-0540
Mailing Address - Fax:
Practice Address - Street 1:700 ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-2703
Practice Address - Country:US
Practice Address - Phone:618-802-0540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043116835164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse