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

Table of content: GEORGE FILIP MS, LPC (NPI 1124904982)

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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