Healthcare Provider Details

I. General information

NPI: 1972033645
Provider Name (Legal Business Name): HANNAH MERRIFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102017 MAJESTIC PALM CIRCLE APT 302
RIVERVIEW FL
33578
US

IV. Provider business mailing address

10207 MAJESTIC PALM CIR APT 302
RIVERVIEW FL
33578-9443
US

V. Phone/Fax

Practice location:
  • Phone: 570-560-0109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: