Provider Demographics
NPI:1720369374
Name:PAGE, CHERYL LYNNE (PCA)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNNE
Last Name:PAGE
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 876346
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6346
Mailing Address - Country:US
Mailing Address - Phone:907-715-8570
Mailing Address - Fax:907-892-1102
Practice Address - Street 1:12370 W BENCH LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:AK
Practice Address - Zip Code:99694
Practice Address - Country:US
Practice Address - Phone:907-892-1112
Practice Address - Fax:907-892-1102
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker