Provider Demographics
NPI:1124759857
Name:PAYNE, COURTNEY MARIE (LPN)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BEREHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1873
Mailing Address - Country:US
Mailing Address - Phone:716-710-0234
Mailing Address - Fax:
Practice Address - Street 1:116 BEREHAVEN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1873
Practice Address - Country:US
Practice Address - Phone:716-710-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344339164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse