Provider Demographics
NPI:1497582316
Name:PAYE, MARC DAVIS
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:DAVIS
Last Name:PAYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BROADWAY AVE N
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-3720
Mailing Address - Country:US
Mailing Address - Phone:507-206-0840
Mailing Address - Fax:507-206-0318
Practice Address - Street 1:113 BROADWAY AVE N
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55906-3720
Practice Address - Country:US
Practice Address - Phone:507-206-0840
Practice Address - Fax:507-206-0318
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3104A0630X, 311500000X, 314000000X
MN10832685376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility