Provider Demographics
NPI:1689385247
Name:DOORNBOS, PAGE ELAINE (CNP)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:ELAINE
Last Name:DOORNBOS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 E CURTIS ST
Mailing Address - Street 2:
Mailing Address - City:STRYKER
Mailing Address - State:OH
Mailing Address - Zip Code:43557-9468
Mailing Address - Country:US
Mailing Address - Phone:419-670-3684
Mailing Address - Fax:
Practice Address - Street 1:15145 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-9619
Practice Address - Country:US
Practice Address - Phone:419-904-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032606363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health