Basic Information
| Provider Information | |||||||||
| NPI: | 1568875193 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PAYNE | ||||||||
| FirstName: | LAUREL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9489 E STAR WATER DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857498706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417846719 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2120 EXCHANGE ST | ||||||||
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| City: | ASTORIA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971033365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033255722 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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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 | 2084P0804X | DO189833 | OR | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084P0800X | DO189833 | OR | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.