MEDICARE: MR. MYRON CURTIS PAGE JR. CNA

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	376K00000X	Nurse's Aide	230009617610912	MI

General Provider Information

NPI Number	:	1811599301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MYRON CURTIS PAGE JR. CNA

Provider Business Mailing Address
First Line	:	14245 WESTBROOK ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-2618
Country	:	US
Telephone Number	:	313-244-2185
Fax Number	:

Provider Business Practice Location Address
First Line	:	14245 WESTBROOK ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48223-2618
Country	:	US
Telephone Number	:	313-244-2185
Fax Number	:

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

Provider Enumeration Date	:	11/10/2020
Last Update Date	:	11/10/2020

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