Provider Demographics
NPI:1841877495
Name:PAYNE, DANIELLE R (FNP)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:R
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9340
Mailing Address - Country:US
Mailing Address - Phone:260-348-5021
Mailing Address - Fax:
Practice Address - Street 1:276 MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1701
Practice Address - Country:US
Practice Address - Phone:260-563-2126
Practice Address - Fax:260-563-2120
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011541A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily