Provider Demographics
NPI:1447726823
Name:CARROLL, PAYTON ELIZABETH (MA)
Entity type:Individual
Prefix:
First Name:PAYTON
Middle Name:ELIZABETH
Last Name:CARROLL
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:ELIZABETH
Other - Last Name:BRULAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4704 W PATTERSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3612
Mailing Address - Country:US
Mailing Address - Phone:360-961-8710
Mailing Address - Fax:
Practice Address - Street 1:4700 W 95TH ST STE LL5
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2575
Practice Address - Country:US
Practice Address - Phone:708-684-9217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program