Provider Demographics
NPI:1841239597
Name:PAIGE, CORDIE KAY
Entity type:Individual
Prefix:MRS
First Name:CORDIE
Middle Name:KAY
Last Name:PAIGE
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 1:17 BRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1652
Mailing Address - Country:US
Mailing Address - Phone:330-301-6628
Mailing Address - Fax:
Practice Address - Street 1:229 GORDON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1667
Practice Address - Country:US
Practice Address - Phone:330-599-1908
Practice Address - Fax:330-755-0770
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN102300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2432755Medicaid