Healthcare Provider Details

I. General information

NPI: 1649291766
Provider Name (Legal Business Name): SUZANNE MARGUERITE PAYTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 01/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 E MCKELLIPS RD SUITE 101
MESA AZ
85203-9645
US

IV. Provider business mailing address

840 E MCKELLIPS RD SUITE 101
MESA AZ
85203-9645
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-7546
  • Fax: 480-833-8313
Mailing address:
  • Phone: 480-834-7546
  • Fax: 480-833-8313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP0464
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN026496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: