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General NPI Number Information
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NPI Number | 1154708865
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Entity Type | Individual
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Provider Name | ANGELA PAYNE LPN
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Gender | Female
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Dates
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Enumeration Date | 05/01/2015
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Last Update Date | 05/01/2015
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Provider Practice Location Address
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Address Line | 12965 E MADRID ST
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City | DEWEY
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State | AZ
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Zip | 86327-7223
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Country | US
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Telephone | 520-661-0592
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Fax |
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Provider Business Mailing Address
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Address Line | 12965 E MADRID ST
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City | DEWEY
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State | AZ
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Zip | 86327-7223
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Country | US
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Telephone | 520-661-0592
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LP048161
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License Number State | AZ
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