Provider Demographics
NPI:1336947639
Name:CROWN-PAYNE, KANDICE LYNNETTE-ZOPHIA
Entity type:Individual
Prefix:
First Name:KANDICE
Middle Name:LYNNETTE-ZOPHIA
Last Name:CROWN-PAYNE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 287TH PL NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-4521
Mailing Address - Country:US
Mailing Address - Phone:360-661-9605
Mailing Address - Fax:
Practice Address - Street 1:6914 287TH PL NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-4521
Practice Address - Country:US
Practice Address - Phone:360-661-9605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60864523163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency