Healthcare Provider Details

I. General information

NPI: 1265135198
Provider Name (Legal Business Name): CHAD DANIEL MERRILL AG-ACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HIGH ST
LEWISTON ME
04240-7616
US

IV. Provider business mailing address

24B UPLAND RD
LISBON ME
04250-6803
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP231086
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: