Healthcare Provider Details

I. General information

NPI: 1114932894
Provider Name (Legal Business Name): DONNA L PAYNE-SNYDER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1812 S J ST SUITE 120
TACOMA WA
98405-4964
US

IV. Provider business mailing address

1812 S J ST SUITE 120
TACOMA WA
98405-4964
US

V. Phone/Fax

Practice location:
  • Phone: 253-207-4890
  • Fax: 253-207-4871
Mailing address:
  • Phone: 253-207-4890
  • Fax: 253-207-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP30004139
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberAP30004139
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: