Provider Demographics
NPI:1790859106
Name:PAGE, LORI A (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:PAGE
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 1:5535 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POTOSI
Mailing Address - State:WI
Mailing Address - Zip Code:53820-9621
Mailing Address - Country:US
Mailing Address - Phone:608-763-2596
Mailing Address - Fax:
Practice Address - Street 1:5535 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:POTOSI
Practice Address - State:WI
Practice Address - Zip Code:53820-9621
Practice Address - Country:US
Practice Address - Phone:608-763-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38272900Medicaid