Provider Demographics
NPI:1316001605
Name:PAYNE, PATRICIA ELIZABETH (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ELIZABETH
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 1:320 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:IN
Mailing Address - Zip Code:47359-1136
Mailing Address - Country:US
Mailing Address - Phone:765-729-0057
Mailing Address - Fax:
Practice Address - Street 1:320 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:IN
Practice Address - Zip Code:47359-1136
Practice Address - Country:US
Practice Address - Phone:765-729-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27044026A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse