Provider Demographics
NPI:1851647127
Name:PAGE, GLENDA JEAN (STNA)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:JEAN
Last Name:PAGE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 BURGESS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2636
Mailing Address - Country:US
Mailing Address - Phone:937-903-4519
Mailing Address - Fax:
Practice Address - Street 1:513 BURGESS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2636
Practice Address - Country:US
Practice Address - Phone:937-903-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401268180711374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide