Healthcare Provider Details

I. General information

NPI: 1487143186
Provider Name (Legal Business Name): PATRICIA PAYNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 EL PASO RD
RUIDOSO NM
88345-6033
US

IV. Provider business mailing address

PO BOX 1112
CARRIZOZO NM
88301-1112
US

V. Phone/Fax

Practice location:
  • Phone: 575-630-7974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR46489
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: