1629197660 NPI number — MS. EVELYN NADINE MERRIETT APRN-C

Table of content: MS. EVELYN NADINE MERRIETT APRN-C (NPI 1629197660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629197660 NPI number — MS. EVELYN NADINE MERRIETT APRN-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRIETT
Provider First Name:
EVELYN
Provider Middle Name:
NADINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629197660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8532 W CAPITOL DR STE 201
Provider Second Line Business Mailing Address:
# 201 PULMEDIX ASTHMA CARE CENTER & PFT LAB.
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53222-1850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-393-4002
Provider Business Mailing Address Fax Number:
414-393-4014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8532 W CAPITOL DR STE 201
Provider Second Line Business Practice Location Address:
# 201
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-1850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-393-4002
Provider Business Practice Location Address Fax Number:
414-393-4014
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1594 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1594 APNP , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0339855 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 65810-30 . This is a "REGISTERED NURSE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".




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