Provider Demographics
NPI:1649291766
Name:PAYTON, SUZANNE MARGUERITE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARGUERITE
Last Name:PAYTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E MCKELLIPS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9645
Mailing Address - Country:US
Mailing Address - Phone:480-834-7546
Mailing Address - Fax:480-833-8313
Practice Address - Street 1:840 E MCKELLIPS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-9645
Practice Address - Country:US
Practice Address - Phone:480-834-7546
Practice Address - Fax:480-833-8313
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN026496163W00000X
AZAP0464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
82694Medicare ID - Type Unspecified