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General NPI Number Information
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NPI Number | 1255870556
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Entity Type | Individual
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Provider Name | COURTNEY PAYNE P.A.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 5308 HARROUN RD # 285
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City | SYLVANIA
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State | OH
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Zip | 43560-2193
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Country | US
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Telephone | 419-824-5633
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Fax | 419-824-5953
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE
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City | TOLEDO
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State | OH
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Zip | 43604-1516
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50.004996RX
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 50.004996RX
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License Number State | OH
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