Healthcare Provider Details

I. General information

NPI: 1144832874
Provider Name (Legal Business Name): LORRAINE K MERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 N WILMOT RD STE 101
TUCSON AZ
85711-2683
US

IV. Provider business mailing address

PO BOX 806
SAINT DAVID AZ
85630-0806
US

V. Phone/Fax

Practice location:
  • Phone: 520-694-8888
  • Fax:
Mailing address:
  • Phone: 928-243-2383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN128057
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRNP304009
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: