Provider Demographics
NPI:1699967257
Name:PAGE, ALLISON JEAN (APRN)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JEAN
Last Name:PAGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 BONANZA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-7239
Mailing Address - Country:US
Mailing Address - Phone:435-513-2715
Mailing Address - Fax:
Practice Address - Street 1:1670 BONANZA DR STE 203
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7239
Practice Address - Country:US
Practice Address - Phone:355-132-7154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2067404405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner