MEDICARE: CRYSTAL PAYTON

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	164W00000X	Licensed Practical Nurse	PN.138061-M-IV	OH
2	164W00000X	Licensed Practical Nurse	PN138061	OH

General Provider Information

NPI Number	:	1104217868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL PAYTON

Provider Business Mailing Address
First Line	:	2914 RAVOGLI AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2914 RAVOGLI AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7817
Country	:	US
Telephone Number	:	513-252-8718
Fax Number	:

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

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	03/05/2015

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Directions to “ CRYSTAL PAYTON ” Practice Location

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