Provider Demographics
NPI:1588918577
Name:ARTZ-PAYNE, MARI-LOU (LPN)
Entity type:Individual
Prefix:
First Name:MARI-LOU
Middle Name:
Last Name:ARTZ-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 1:240 NORTH A STREET
Mailing Address - Street 2:PO BOX 2050
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321
Mailing Address - Country:US
Mailing Address - Phone:360-829-6162
Mailing Address - Fax:360-829-3391
Practice Address - Street 1:240 A STREET
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-2050
Practice Address - Country:US
Practice Address - Phone:360-829-6162
Practice Address - Fax:360-829-3391
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP 00021806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA164W00000XMedicaid