Provider Demographics
NPI:1801126271
Name:PAYNE, SHERRIE ANNE (RT (R))
Entity type:Individual
Prefix:
First Name:SHERRIE
Middle Name:ANNE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3387 E WILSON DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-6167
Mailing Address - Country:US
Mailing Address - Phone:317-831-6878
Mailing Address - Fax:
Practice Address - Street 1:3387 E WILSON DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-6167
Practice Address - Country:US
Practice Address - Phone:317-831-6878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INXT017693247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist