Provider Demographics
NPI:1003095480
Name:PAYNE, CHELSEA BIANCA (MD)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:BIANCA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:EIELSON AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99702
Mailing Address - Country:US
Mailing Address - Phone:907-377-6722
Mailing Address - Fax:
Practice Address - Street 1:2630 CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702
Practice Address - Country:US
Practice Address - Phone:907-377-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program