Provider Demographics
NPI:1992773758
Name:PAGE, MICHELLE L (FNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:PAGE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 EAST MARICOPA DR
Mailing Address - Street 2:PO BOX 1504
Mailing Address - City:SPRINGERVILLE
Mailing Address - State:AZ
Mailing Address - Zip Code:85938-1540
Mailing Address - Country:US
Mailing Address - Phone:928-655-4444
Mailing Address - Fax:
Practice Address - Street 1:1616 CORNWALL AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4648
Practice Address - Country:US
Practice Address - Phone:306-676-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2336953363LF0000X, 363LP2300X
AZAP0890363LF0000X, 363LF0000X
CANP11518363LF0000X
MECNP171180363LF0000X
CARN566238363LP2300X, 363LP2300X
WAAP60911397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ495532Medicaid
AZD06199741OtherDRIVERS LIC
MA495532Medicaid