Provider Demographics
NPI:1396439352
Name:PAGE, HEATHER SHAWN (RN, CCM)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:SHAWN
Last Name:PAGE
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 E BRIEF RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-1025
Mailing Address - Country:US
Mailing Address - Phone:704-904-7182
Mailing Address - Fax:
Practice Address - Street 1:4222 E BRIEF RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-1025
Practice Address - Country:US
Practice Address - Phone:704-904-7182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61008537163WC0400X
NC197601163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management