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General NPI Number Information
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NPI Number | 1740295617
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Entity Type | Individual
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Provider Name | PAIGE A LEAVITT-HALSALL
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Gender | Female
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 02/17/2011
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Provider Practice Location Address
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Address Line | 104 CHARLES ELDRIDGE DRIVE TRANQUIL MIND & WELLNESS INC
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City | LAKEVILLE
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State | MA
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Zip | 02347
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Country | US
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Telephone | 508-947-1683
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Fax | 508-947-1684
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Provider Business Mailing Address
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Address Line | 104 CHARLES ELDRIDGE DRIVE
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City | LAKEVILLE
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State | MA
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Zip | 02347
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Country | US
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Telephone | 508-947-1683
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Fax | 508-947-1684
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | APRN175441
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | APRN175441
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License Number State | MA
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