Healthcare Provider Details

I. General information

NPI: 1114629789
Provider Name (Legal Business Name): ANDRIA PAYNE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 WICKFORD POINT DR
TOLEDO OH
43607-2129
US

IV. Provider business mailing address

4253 WICKFORD POINT DR
TOLEDO OH
43607-2129
US

V. Phone/Fax

Practice location:
  • Phone: 567-420-7336
  • Fax:
Mailing address:
  • Phone: 567-970-1026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number187384
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: