Healthcare Provider Details

I. General information

NPI: 1023366382
Provider Name (Legal Business Name): MARY E PAYNE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 ML KING JR WAY S SUITE 100
SEATTLE WA
98108-2182
US

IV. Provider business mailing address

4515 ML KING JR WAY S SUITE 100
SEATTLE WA
98108-2182
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-5325
  • Fax: 206-320-5326
Mailing address:
  • Phone: 206-320-5325
  • Fax: 206-320-5326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN00045130
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: