Doctor Name: | SANDRA LEE PAYNE |
NPI Number: | 1073705430 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | APRN |
License Number: | 3314 |
Business Practice Address: | 1010 Highway 17 N North Myrtle Beach, SC - 295822806 |
Business Phone Number: | 8432491451 |
Business Fax Number: | |
Mailing Address: | 1010 Highway 17 N, NORTH MYRTLE BEACH |
State: | SC |
Postal Code: | 295822806 |
Phone Number: | 8432491451 |
Fax Number: | |
NPI Enumeration Date: | 08/09/2007 |
NPI Last Update Date: | 06/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3314 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |