Basic Information
| Provider Information | |||||||||
| NPI: | 1740716927 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PAGE | ||||||||
| FirstName: | SUZAN | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7780 S BROADWAY STE 380 | ||||||||
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| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801222633 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 190 RIVERVIEW ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287342658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283496800 | ||||||||
| FaxNumber: | 8283496810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2017 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5012981 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LG0600X | APN.0993052.NP | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 1740716927 | 05 | NC | MEDICAID |