MEDICARE: LUCRETIA PAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1336403526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCRETIA PAGE

Provider Business Mailing Address
First Line	:	3837 PECOS PARK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6626
Country	:	US
Telephone Number	:	702-300-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	3837 PECOS PARK AVE
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89081-6626
Country	:	US
Telephone Number	:	702-300-8989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	07/02/2012

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Directions to “ LUCRETIA PAGE ” Practice Location

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