Healthcare Provider Details

I. General information

NPI: 1477133684
Provider Name (Legal Business Name): PAYDEN WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2641 DEVELOPMENT DR
GREEN BAY WI
54311-4240
US

IV. Provider business mailing address

744 S WEBSTER AVE MEDICAL STAFF SERVICES
GREEN BAY WI
54301-3505
US

V. Phone/Fax

Practice location:
  • Phone: 920-338-6868
  • Fax: 920-338-6869
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0075665
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number86918
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: