Provider Demographics
NPI:1245887637
Name:BOAKAI-PAYNE, FLORENCE
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:
Last Name:BOAKAI-PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19195 ZANE ST NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-2829
Mailing Address - Country:US
Mailing Address - Phone:763-412-0078
Mailing Address - Fax:
Practice Address - Street 1:19195 ZANE ST NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2829
Practice Address - Country:US
Practice Address - Phone:763-412-0078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2469160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse