Provider Demographics
NPI:1265697874
Name:PAGE, NANCY JOHNSON (RD,LDN)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOHNSON
Last Name:PAGE
Suffix:
Gender:F
Credentials:RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 GLEN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-3316
Mailing Address - Country:US
Mailing Address - Phone:412-854-1466
Mailing Address - Fax:
Practice Address - Street 1:5660 GLEN HILL DR
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-3316
Practice Address - Country:US
Practice Address - Phone:412-854-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000195133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered