Provider Demographics
NPI:1043927924
Name:PAYNE, ISA (APN)
Entity Type:Individual
Prefix:
First Name:ISA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 SAWGRASS CT
Mailing Address - Street 2:
Mailing Address - City:MAYS LANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330-3248
Mailing Address - Country:US
Mailing Address - Phone:609-442-1563
Mailing Address - Fax:
Practice Address - Street 1:1313 SAWGRASS CT
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3248
Practice Address - Country:US
Practice Address - Phone:609-442-1563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR16957300163WM0705X
NJ26NJ01392900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical