Provider Demographics
NPI:1801819693
Name:PAYNE, LESLIE MILLER (CPM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:MILLER
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2406
Mailing Address - Country:US
Mailing Address - Phone:434-384-9602
Mailing Address - Fax:434-384-9603
Practice Address - Street 1:1525 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2406
Practice Address - Country:US
Practice Address - Phone:434-384-9602
Practice Address - Fax:434-384-9603
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000001176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife