Provider Demographics
NPI:1720770498
Name:PAGE, JACQUELYN NICOLE (CNA)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:NICOLE
Last Name:PAGE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:NICOLE
Other - Last Name:HANNAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49037-3021
Mailing Address - Country:US
Mailing Address - Phone:269-578-1379
Mailing Address - Fax:
Practice Address - Street 1:117 OAKLAWN AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49037-3021
Practice Address - Country:US
Practice Address - Phone:269-578-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000035833376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide