Provider Demographics
NPI:1629499678
Name:PAGE, BERNICE MCCORVEY (MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:MCCORVEY
Last Name:PAGE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-2048
Mailing Address - Fax:225-765-1958
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-2048
Practice Address - Fax:225-765-1958
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO7491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2359720Medicaid
346084YJA2Medicare PIN