MEDICARE: MRS. MIRIAM MICHELLE PAYNE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0200X	Critical Care Medicine Registered Nurse	RN147591	OH

General Provider Information

NPI Number	:	1326472143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRIAM MICHELLE PAYNE RN

Provider Business Mailing Address
First Line	:	23613 S FRONTENAC DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-4950
Country	:	US
Telephone Number	:	216-403-7017
Fax Number	:

Provider Business Practice Location Address
First Line	:	23613 S FRONTENAC DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-4950
Country	:	US
Telephone Number	:	216-403-7017
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/28/2013

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