1184330060 NPI number — JOANNE RAE PAYNE R.N CERTIFIED CAPPA

Table of content: JOANNE RAE PAYNE R.N CERTIFIED CAPPA (NPI 1184330060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184330060 NPI number — JOANNE RAE PAYNE R.N CERTIFIED CAPPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAYNE
Provider First Name:
JOANNE
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N CERTIFIED CAPPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAYNE
Provider Other First Name:
JOANNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N B.SN DOULA CLD.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184330060
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
441 PONTEVEDRA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33837-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-772-5031
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 PONTEVEDRA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAVENPORT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33837-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-772-5031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374J00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SSN , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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