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General NPI Number Information
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NPI Number | 1184219602
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Entity Type | Individual
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Provider Name | XAN PAYNE FNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 26700 AZ-85
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City | BUCKEYE
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State | AZ
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Zip | 85326-8532
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Country | US
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Telephone | 623-386-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 11305 W PINEHOLLOW DR
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City | SURPRISE
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State | AZ
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Zip | 85378-9344
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Country | US
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Telephone | 863-307-0189
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 255191
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License Number State | AZ
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