Provider Demographics
NPI:1578321246
Name:PAGE, FARRAH NATASHA (RN)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:NATASHA
Last Name:PAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FARRAH
Other - Middle Name:
Other - Last Name:WILDFONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1825 PASSOLT ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-4058
Mailing Address - Country:US
Mailing Address - Phone:989-890-8147
Mailing Address - Fax:
Practice Address - Street 1:1825 PASSOLT ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-4058
Practice Address - Country:US
Practice Address - Phone:989-798-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704346389163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool