Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704126433 | MI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4704126433 | MI |
NPI | 1023195286 |
---|---|
Provider Name | Mary Kathryn Payne |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48104-6796 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 25/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4704507 | (05) | MI |
P22077 | (02) | MI |