Provider Demographics
NPI:1891762779
Name:PAYNE, JENNIE DARE CHAPMAN (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIE DARE
Middle Name:CHAPMAN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E COMMERCE STREET
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1532
Mailing Address - Country:US
Mailing Address - Phone:248-453-6643
Mailing Address - Fax:888-746-5634
Practice Address - Street 1:560 N MILFORD RD STE 202
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1532
Practice Address - Country:US
Practice Address - Phone:248-892-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003830363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP74969Medicare UPIN