Provider Demographics
NPI:1609210228
Name:BURTON, PAIGE D (LPN)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:D
Last Name:BURTON
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 1:7494 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-8575
Mailing Address - Country:US
Mailing Address - Phone:318-469-3889
Mailing Address - Fax:
Practice Address - Street 1:7494 N LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-8575
Practice Address - Country:US
Practice Address - Phone:318-469-3889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20100009164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse