Provider Demographics
NPI:1578015640
Name:PAYNE, MARLENA (BHS)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 CLEVENGER DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-1016
Mailing Address - Country:US
Mailing Address - Phone:209-204-2799
Mailing Address - Fax:
Practice Address - Street 1:800 SCENIC DR BLDG D
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-6131
Practice Address - Country:US
Practice Address - Phone:209-581-4483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374700000XNursing Service Related ProvidersTechnician