Provider Demographics
NPI:1831394980
Name:BACKUS, PAGE ELIZABETH
Entity type:Individual
Prefix:
First Name:PAGE
Middle Name:ELIZABETH
Last Name:BACKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 LAVENDER LN
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-3627
Mailing Address - Country:US
Mailing Address - Phone:541-664-4677
Mailing Address - Fax:
Practice Address - Street 1:168 LAVENDER LN
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-3627
Practice Address - Country:US
Practice Address - Phone:541-664-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR90155121870804D177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging