Provider Demographics
NPI:1881339364
Name:PAYNE, ELIZABETH BLAIR (RN, BA)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BLAIR
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 GORDONS FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-4083
Mailing Address - Country:US
Mailing Address - Phone:434-946-0691
Mailing Address - Fax:434-946-0258
Practice Address - Street 1:165 GORDONS FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-4083
Practice Address - Country:US
Practice Address - Phone:434-946-0691
Practice Address - Fax:434-946-0258
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212537163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool