Provider Demographics
NPI:1003969833
Name:PAYNE, MOLLY A (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MOLLY
Middle Name:A
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3103
Mailing Address - Country:US
Mailing Address - Phone:716-903-8998
Mailing Address - Fax:
Practice Address - Street 1:277 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-3103
Practice Address - Country:US
Practice Address - Phone:716-903-8998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145494130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse