MEDICARE: ALLISON JEAN PAGE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	2067404405	UT

General Provider Information

NPI Number	:	1699967257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON JEAN PAGE APRN

Provider Business Mailing Address
First Line	:	1670 BONANZA DR STE 203
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7239
Country	:	US
Telephone Number	:	435-513-2715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1670 BONANZA DR STE 203
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-7239
Country	:	US
Telephone Number	:	355-132-7154
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	08/31/2023

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Directions to “ ALLISON JEAN PAGE APRN” Practice Location

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