Provider Demographics
NPI:1134164478
Name:PAYNE, PATRICIA P
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:P
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:NEWMAN
Other - Last Name:PUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1715
Mailing Address - Country:US
Mailing Address - Phone:856-546-3006
Mailing Address - Fax:856-547-3178
Practice Address - Street 1:210 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1715
Practice Address - Country:US
Practice Address - Phone:856-546-3006
Practice Address - Fax:856-547-3178
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00069600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner