Individual
JARAE REGINA PAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP-AC
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-2644
Mailing address
1131 ASHBOURNE RD, CHELTENHAM, PA 19012-1108
(215) 528-9895
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
R246255
MD
363LP0200X
Pediatric Nurse Practitioner
Primary
SP023276
PA
Other
Enumeration date
02/04/2021
Last updated
02/23/2021
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