Provider Demographics
NPI:1174125173
Name:PAGE, KAREN ELAINE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:ELAINE
Last Name:PAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 FERNHURST AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2829
Mailing Address - Country:US
Mailing Address - Phone:440-655-0579
Mailing Address - Fax:
Practice Address - Street 1:6413 FERNHURST AVE
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-2829
Practice Address - Country:US
Practice Address - Phone:440-655-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHGGS1813347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle