Provider Demographics
NPI:1841052248
Name:PAGE, FANNISHA IS (CHW)
Entity type:Individual
Prefix:
First Name:FANNISHA
Middle Name:IS
Last Name:PAGE
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:FANNISHA
Other - Middle Name:IS
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FANNISHA TURNER
Mailing Address - Street 1:525 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1628
Mailing Address - Country:US
Mailing Address - Phone:614-500-9494
Mailing Address - Fax:
Practice Address - Street 1:525 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1628
Practice Address - Country:US
Practice Address - Phone:614-500-9494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator