Healthcare Provider Details

I. General information

NPI: 1841239597
Provider Name (Legal Business Name): MRS. CORDIE KAY PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 GORDON AVE
CAMPBELL OH
44405-1667
US

IV. Provider business mailing address

17 BRIGHT AVE
CAMPBELL OH
44405-1652
US

V. Phone/Fax

Practice location:
  • Phone: 330-599-1908
  • Fax: 330-755-0770
Mailing address:
  • Phone: 330-301-6628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN102300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: