Provider Demographics
NPI:1326472143
Name:PAYNE, MIRIAM MICHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:MICHELLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MIRIAM
Other - Middle Name:MICHELLE
Other - Last Name:GROOMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:23613 S FRONTENAC DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4950
Mailing Address - Country:US
Mailing Address - Phone:216-403-7017
Mailing Address - Fax:
Practice Address - Street 1:23613 S FRONTENAC DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4950
Practice Address - Country:US
Practice Address - Phone:216-403-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN147591163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine