Provider Demographics
NPI:1083802797
Name:PAYNTER, TERESA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:
Last Name:PAYNTER
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 1:3001 W MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2366
Mailing Address - Country:US
Mailing Address - Phone:623-322-8454
Mailing Address - Fax:
Practice Address - Street 1:3001 W MATTHEW DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-2366
Practice Address - Country:US
Practice Address - Phone:623-322-8454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP018637251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)