Healthcare Provider Details

I. General information

NPI: 1043824741
Provider Name (Legal Business Name): MERRY JO BINKLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CANAL ST
MALDEN MA
02148-6701
US

IV. Provider business mailing address

3920 N HIGHWAY A1A APT 601
HUTCHINSON ISLAND FL
34949-8543
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-0500
  • Fax:
Mailing address:
  • Phone: 772-321-1517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2268922
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: