Healthcare Provider Details

I. General information

NPI: 1639413297
Provider Name (Legal Business Name): LEMLEM W PAYNE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 AUSTIN WAY
SANTA ROSA CA
95404-3608
US

IV. Provider business mailing address

1828 AUSTIN WAY
SANTA ROSA CA
95404-3608
US

V. Phone/Fax

Practice location:
  • Phone: 707-758-7362
  • Fax: 707-408-2083
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95016614
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number767996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: