Healthcare Provider Details

I. General information

NPI: 1558276394
Provider Name (Legal Business Name): PAYTEN RAYE ANDERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 10TH AVE STE 101
MENOMINEE MI
49858-3058
US

IV. Provider business mailing address

2621 PARKRIDGE AVE
MARINETTE WI
54143-1524
US

V. Phone/Fax

Practice location:
  • Phone: 906-424-0903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number388177
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: