Healthcare Provider Details

I. General information

NPI: 1427481381
Provider Name (Legal Business Name): EDDIE PAYNE JR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9133 WINTON RD APT 20
CINCINNATI OH
45231-3843
US

IV. Provider business mailing address

3652 READING RD APT 214
CINCINNATI OH
45229-2174
US

V. Phone/Fax

Practice location:
  • Phone: 513-478-0831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number46-3171996
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: