Healthcare Provider Details

I. General information

NPI: 1720875610
Provider Name (Legal Business Name): MANDIE MERKSICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 19TH AVE
COUNCIL BLUFFS IA
51501-7218
US

IV. Provider business mailing address

7110 F ST
OMAHA NE
68117-1014
US

V. Phone/Fax

Practice location:
  • Phone: 402-455-4648
  • Fax:
Mailing address:
  • Phone: 405-455-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: