Provider Demographics
NPI:1689460024
Name:PAYNE, ANGEL MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:ANGEL
Middle Name:MARIE
Last Name:PAYNE
Suffix:
Gender:
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10037 KINGSBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5471
Mailing Address - Country:US
Mailing Address - Phone:216-338-4093
Mailing Address - Fax:
Practice Address - Street 1:8101 EUCLID AVE STE 21
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-5059
Practice Address - Country:US
Practice Address - Phone:216-472-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1092105164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse