Healthcare Provider Details

I. General information

NPI: 1356926745
Provider Name (Legal Business Name): PAIGE OSTLUND NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST STE 205
NORTHRIDGE CA
91325-5408
US

IV. Provider business mailing address

312 RAYMONDALE DR APT B
SOUTH PASADENA CA
91030-2120
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-2977
  • Fax:
Mailing address:
  • Phone: 626-437-8991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: