Provider Demographics
NPI:1164959060
Name:PAYNE, CHAUNA YVETTE
Entity Type:Individual
Prefix:MS
First Name:CHAUNA
Middle Name:YVETTE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-4101
Mailing Address - Country:US
Mailing Address - Phone:618-580-2584
Mailing Address - Fax:618-551-3005
Practice Address - Street 1:333 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62223-4101
Practice Address - Country:US
Practice Address - Phone:618-580-2584
Practice Address - Fax:618-551-3005
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL335E00000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891230744OtherNPI