Healthcare Provider Details

I. General information

NPI: 1558978098
Provider Name (Legal Business Name): PAIGE CISAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 PRINCESS ANNE RD STE 200
VIRGINIA BEACH VA
23462-3321
US

IV. Provider business mailing address

5511 PRINCESS ANNE RD STE 200
VIRGINIA BEACH VA
23462-3321
US

V. Phone/Fax

Practice location:
  • Phone: 757-704-4747
  • Fax:
Mailing address:
  • Phone: 757-704-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number218297
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number249198
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: