MEDICARE: MS. DIANE E PAGE CRNP

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	363A00000X	Physician Assistant	R164969	MD
2	363LF0000X	Family Nurse Practitioner	ARNP9401308	FL
3	163W00000X	Registered Nurse	R164969	MD

General Provider Information

NPI Number	:	1497730436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANE E PAGE CRNP

Provider Business Mailing Address
First Line	:	5011 GREEN MOUNTAIN CIR UNIT 1
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2434
Country	:	US
Telephone Number	:	410-303-1228
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 GREEN MOUNTAIN CIR UNIT 1
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2434
Country	:	US
Telephone Number	:	410-303-1228
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	08/31/2021

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