Provider Demographics
NPI:1124344098
Name:PAGE-HARRIS, EVANGELINE
Entity type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:
Last Name:PAGE-HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVANGELINE
Other - Middle Name:
Other - Last Name:PAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:485 SAINT PAULS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2101
Mailing Address - Country:US
Mailing Address - Phone:718-876-5578
Mailing Address - Fax:
Practice Address - Street 1:485 SAINT PAULS AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2101
Practice Address - Country:US
Practice Address - Phone:718-876-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293229-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse