Provider Demographics
NPI:1598760779
Name:PAGE, LYNDA L (ARNP, NNP)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:L
Last Name:PAGE
Suffix:
Gender:F
Credentials:ARNP, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1897
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-1897
Mailing Address - Country:US
Mailing Address - Phone:316-268-8131
Mailing Address - Fax:316-291-4788
Practice Address - Street 1:3600 E HARRY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3713
Practice Address - Country:US
Practice Address - Phone:316-689-5475
Practice Address - Fax:316-691-6772
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-44422-051363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200256380AMedicaid