Individual
TONI R PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF PEDIATRICS, SHREVEPORT, LA 71103-4228
(318) 675-8600
(318) 675-8638
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN068449
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1162167
—
LA
01
—
4C627F600
MEDICARE - PTAN
LA
Enumeration date
07/16/2006
Last updated
08/19/2014
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