Provider Demographics
NPI:1912974874
Name:PAYNE, PAMELA ANGERER (RNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANGERER
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2840
Mailing Address - Country:US
Mailing Address - Phone:626-285-2542
Mailing Address - Fax:213-327-0977
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:SUITE 440
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-440-9190
Practice Address - Fax:626-440-0632
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN477086363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS49617Medicare UPIN