Basic Information
| Provider Information | |||||||||
| NPI: | 1265514434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYNE | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 469 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992100469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092328160 | ||||||||
| FaxNumber: | 5092328392 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992013825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5092328160 | ||||||||
| FaxNumber: | 5092328392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 12/28/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | DI00001404 | WA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
ID Information
| ID | Type | State | Issuer | Description | 7122724 | 05 | WA | MEDICAID | P00161890 | 01 | WA | RAILROAD MEDICARE | OTHER |