Healthcare Provider Details

I. General information

NPI: 1922323385
Provider Name (Legal Business Name): JACQUELYN M. MERCEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 TOWN BROOKE
MIDDLETOWN CT
06457-6633
US

IV. Provider business mailing address

4111 TOWN BROOKE
MIDDLETOWN CT
06457-6633
US

V. Phone/Fax

Practice location:
  • Phone: 860-280-7505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number001049
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: