Provider Demographics
NPI:1588939110
Name:PAYNE-RHOULI, MARYAM (RN)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:PAYNE-RHOULI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:PAYNE-RHOULI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1220 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-4904
Mailing Address - Country:US
Mailing Address - Phone:718-792-2752
Mailing Address - Fax:
Practice Address - Street 1:1230 ZEREGA AVE
Practice Address - Street 2:ROOM 46
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5422
Practice Address - Country:US
Practice Address - Phone:718-828-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596787-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse