Provider Demographics
NPI:1265514434
Name:PAYNE, LAURIE ELLEN (RD, CDE)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ELLEN
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 469
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0469
Mailing Address - Country:US
Mailing Address - Phone:509-232-8160
Mailing Address - Fax:509-232-8392
Practice Address - Street 1:601 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-3825
Practice Address - Country:US
Practice Address - Phone:509-232-8160
Practice Address - Fax:509-232-8392
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001404133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7122724Medicaid
WAP00161890OtherRAILROAD MEDICARE
WAP00161890OtherRAILROAD MEDICARE