Provider Demographics
NPI:1134536204
Name:PAYNE, NANNETTE LOUISE (LPN)
Entity type:Individual
Prefix:MRS
First Name:NANNETTE
Middle Name:LOUISE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5027 ETNA RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2531
Mailing Address - Country:US
Mailing Address - Phone:614-260-1926
Mailing Address - Fax:614-694-4895
Practice Address - Street 1:5027 ETNA RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2531
Practice Address - Country:US
Practice Address - Phone:614-260-1926
Practice Address - Fax:614-694-4895
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-081736164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2902925Medicaid