Provider Demographics
NPI:1811599301
Name:PAGE, MYRON CURTIS JR (CNA)
Entity Type:Individual
Prefix:MR
First Name:MYRON
Middle Name:CURTIS
Last Name:PAGE
Suffix:JR
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14245 WESTBROOK ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48223-2618
Mailing Address - Country:US
Mailing Address - Phone:313-244-2185
Mailing Address - Fax:
Practice Address - Street 1:14245 WESTBROOK ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48223-2618
Practice Address - Country:US
Practice Address - Phone:313-244-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230009617610912376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty