Provider Demographics
NPI:1972984839
Name:PAYNE, RENEE N (FNP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:N
Last Name:PAYNE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-5942
Mailing Address - Country:US
Mailing Address - Phone:626-974-1441
Mailing Address - Fax:626-974-1522
Practice Address - Street 1:1135 S SUNSET AVE STE 401
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3921
Practice Address - Country:US
Practice Address - Phone:626-732-8390
Practice Address - Fax:626-974-1522
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily