Healthcare Provider Details

I. General information

NPI: 1760401483
Provider Name (Legal Business Name): ALVIN ELMO MERCER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 N 3RD ST
PHOENIX AZ
85004-1106
US

IV. Provider business mailing address

202 E EARLL DR STE 200
PHOENIX AZ
85012-2647
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-4331
  • Fax:
Mailing address:
  • Phone: 602-808-2800
  • Fax: 602-599-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP6256
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: