MEDICARE: AMANDA MERRITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	6891-S	NV

General Provider Information

NPI Number	:	1811351521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MERRITT

Provider Business Mailing Address
First Line	:	8250 N GRAND CANYON DR
Second Line	:	UNIT 2009
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3725
Country	:	US
Telephone Number	:	725-777-8880
Fax Number	:

Provider Business Practice Location Address
First Line	:	8250 N GRAND CANYON DR
Second Line	:	UNIT 2009
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-3725
Country	:	US
Telephone Number	:	725-777-8880
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	04/08/2016

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Directions to “ AMANDA MERRITT ” Practice Location

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