Healthcare Provider Details

I. General information

NPI: 1437148160
Provider Name (Legal Business Name): MERYIA D THROOP FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2005
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 45011
APO AP
96343-5011
US

IV. Provider business mailing address

UNIT 45011
APO AP
96343-5011
US

V. Phone/Fax

Practice location:
  • Phone: 315-263-4127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1002095
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041-290224
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: