Provider Demographics
NPI:1639589286
Name:PAGE, VERDETTE I
Entity Type:Individual
Prefix:
First Name:VERDETTE
Middle Name:
Last Name:PAGE
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 E CHARLESTON BLVD UNIT 58
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89142-1061
Mailing Address - Country:US
Mailing Address - Phone:702-927-8184
Mailing Address - Fax:
Practice Address - Street 1:5330 E CHARLESTON BLVD UNIT 58
Practice Address - Street 2:5330 E CHARLESTON 58
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89142-1061
Practice Address - Country:US
Practice Address - Phone:702-927-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner