Provider Demographics
NPI:1164971438
Name:PAYNE, CLIFFORD ALEXANDER (R N)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ALEXANDER
Last Name:PAYNE
Suffix:
Gender:M
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5737 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-6012
Mailing Address - Country:US
Mailing Address - Phone:216-338-6670
Mailing Address - Fax:
Practice Address - Street 1:5737 BROOKSIDE RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-6012
Practice Address - Country:US
Practice Address - Phone:216-338-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH234503RN163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)