Provider Demographics
NPI:1114932894
Name:PAYNE-SNYDER, DONNA L (CNM)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:PAYNE-SNYDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 S J ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4964
Mailing Address - Country:US
Mailing Address - Phone:253-207-4890
Mailing Address - Fax:253-207-4871
Practice Address - Street 1:1812 S J ST
Practice Address - Street 2:SUITE 120
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4964
Practice Address - Country:US
Practice Address - Phone:253-207-4890
Practice Address - Fax:253-207-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004139367A00000X, 163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA126540OtherL & I
WA500006585OtherRAILROAD
WA9621434Medicaid
WA175968OtherL & I
WA8931106OtherCRIME VICTIMS
WA500006585OtherRAILROAD
WAG8801256Medicare PIN
WA9621434Medicaid
WAGAB08515Medicare PIN