Provider Demographics
NPI:1750476735
Name:PAGE, CARLENE J (APRN PCNS)
Entity Type:Individual
Prefix:
First Name:CARLENE
Middle Name:J
Last Name:PAGE
Suffix:
Gender:F
Credentials:APRN PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH SERVICE AVENUE
Mailing Address - Street 2:MARIAN HALL 1ST FLOOR
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-456-3649
Mailing Address - Fax:401-752-8116
Practice Address - Street 1:200 HIGH SERVICE AVENUE
Practice Address - Street 2:MARIAN HALL 1ST FLOOR
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-456-3649
Practice Address - Fax:401-752-8116
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN19398PPNS00011364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI306579OtherBLUE CROSS BLUE SHIELD
RI6291652OtherUNITED BEHAVIORAL HEALTH
RI410711OtherBLUE CHIP
RI6291652OtherUNITED BEHAVIORAL HEALTH