Healthcare Provider Details

I. General information

NPI: 1235257742
Provider Name (Legal Business Name): MS. LIZETTE YVONNE PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 DARTFORD AVE
BALTIMORE MD
21229-3317
US

IV. Provider business mailing address

4715 DARTFORD AVE
BALTIMORE MD
21229-3317
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-5607
  • Fax:
Mailing address:
  • Phone: 410-646-5607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberA00020939
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: