Healthcare Provider Details

I. General information

NPI: 1326074121
Provider Name (Legal Business Name): PAULA DONAHUE PAYNE R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 STATION DR
BEALETON VA
22712-9374
US

IV. Provider business mailing address

PO BOX 751 6200 STATION DRIVE
BEALETON VA
22712-0751
US

V. Phone/Fax

Practice location:
  • Phone: 540-364-0153
  • Fax: 540-937-4273
Mailing address:
  • Phone: 540-364-0153
  • Fax: 540-937-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: