MEDICARE: SUSAN RIVERS-PAYNE MSN

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	363L00000X	Nurse Practitioner	RN084379NP05398	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083648109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN RIVERS-PAYNE MSN

Provider Business Mailing Address
First Line	:	519 HOWELL AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45220-1905
Country	:	US
Telephone Number	:	513-861-3001
Fax Number	:	513-559-2020

Provider Business Practice Location Address
First Line	:	1501 MADISON RD FL 3
Second Line	:
City	:	WALNUT HILLS
State	:	OH
Zip	:	45206-1780
Country	:	US
Telephone Number	:	513-354-5238
Fax Number	:	513-354-5237

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/18/2010

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