Provider Demographics
NPI:1619762929
Name:PAYNE, LILLIAN
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 S 81ST ST
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4218
Mailing Address - Country:US
Mailing Address - Phone:402-686-5307
Mailing Address - Fax:
Practice Address - Street 1:6821 S 81ST ST
Practice Address - Street 2:
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-4218
Practice Address - Country:US
Practice Address - Phone:402-686-5307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider