Healthcare Provider Details

I. General information

NPI: 1942461520
Provider Name (Legal Business Name): MS. DONNA MERRITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DONNA MERRITT CNS, NP

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 KINGS COVE CT
INDIANAPOLIS IN
46260-1671
US

IV. Provider business mailing address

1310 KINGS COVE CT
INDIANAPOLIS IN
46260-1671
US

V. Phone/Fax

Practice location:
  • Phone: 317-581-1558
  • Fax:
Mailing address:
  • Phone: 317-581-1558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70000074A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70000074
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: