Provider Demographics
NPI:1144079922
Name:PAGE, TALIA KYRIE (CNM)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:KYRIE
Last Name:PAGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD PALISADE RD APT 1812
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7018
Mailing Address - Country:US
Mailing Address - Phone:941-961-0034
Mailing Address - Fax:
Practice Address - Street 1:1945 US HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8317
Practice Address - Country:US
Practice Address - Phone:941-961-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002295176B00000X
NJ25ME00086700176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife