Individual
ILLYA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6095 MARSHALEE DR, ELKRIDGE, MD 21075-6053
(855) 247-8474
Mailing address
6095 MARSHALEE DR, ELKRIDGE, MD 21075-6053
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015027443
MO
363LF0000X
Family Nurse Practitioner
20164
SC
Other
Enumeration date
05/23/2016
Last updated
05/23/2016
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