Individual
EBONY AKIMA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1637 PARK ST, HARRISBURG, PA 17103-2337
(718) 695-2394
Mailing address
1637 PARK ST, HARRISBURG, PA 17103-2337
(347) 558-0094
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
29117686
PA
Other
Enumeration date
08/08/2019
Last updated
08/08/2019
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