Provider Demographics
NPI:1407298433
Name:PAYNE, DEADRA C (RN)
Entity Type:Individual
Prefix:MS
First Name:DEADRA
Middle Name:C
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1115
Mailing Address - Country:US
Mailing Address - Phone:740-852-6256
Mailing Address - Fax:740-852-6395
Practice Address - Street 1:210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1115
Practice Address - Country:US
Practice Address - Phone:740-852-6256
Practice Address - Fax:740-852-6395
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 374630163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult