Provider Demographics
NPI:1881874022
Name:PAYETTE, ANDREA CAROL (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROL
Last Name:PAYETTE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:CAROL
Other - Last Name:PAYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3950 E PARADISE FALLS DR.
Mailing Address - Street 2:DAVIDSON
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-6684
Mailing Address - Country:US
Mailing Address - Phone:520-232-6817
Mailing Address - Fax:520-232-6816
Practice Address - Street 1:3950 E PARADISE FALLS DR.
Practice Address - Street 2:DAVIDSON
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6684
Practice Address - Country:US
Practice Address - Phone:520-232-6817
Practice Address - Fax:520-232-6816
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN016420163W00000X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD8100Medicaid