Provider Demographics
NPI:1932684495
Name:PAGE, VIVIENNE C
Entity Type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:C
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VIVIENNE
Other - Middle Name:C
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:4064 SERENE DR
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0957
Mailing Address - Country:US
Mailing Address - Phone:469-254-1167
Mailing Address - Fax:
Practice Address - Street 1:4064 SERENE DR
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-0957
Practice Address - Country:US
Practice Address - Phone:469-254-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209463164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse