MEDICARE: MARI-LOU ARTZ-PAYNE LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LP 00021806	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588918577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARI-LOU ARTZ-PAYNE LPN

Provider Business Mailing Address
First Line	:	240 NORTH A STREET
Second Line	:	PO BOX 2050
City	:	BUCKLEY
State	:	WA
Zip	:	98321
Country	:	US
Telephone Number	:	360-829-6162
Fax Number	:	360-829-3391

Provider Business Practice Location Address
First Line	:	240 A STREET
Second Line	:
City	:	BUCKLEY
State	:	WA
Zip	:	98321-2050
Country	:	US
Telephone Number	:	360-829-6162
Fax Number	:	360-829-3391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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