Provider Demographics
NPI:1164591244
Name:PAYNE, MARY (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 WINDING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9170
Mailing Address - Country:US
Mailing Address - Phone:513-697-1596
Mailing Address - Fax:513-697-1596
Practice Address - Street 1:670 WINDING WOODS DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9170
Practice Address - Country:US
Practice Address - Phone:513-478-5300
Practice Address - Fax:513-785-0667
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000337693OtherANTHEM
OH2464542Medicaid
OH2464542Medicaid
NP10803Medicare ID - Type Unspecified