Healthcare Provider Details

I. General information

NPI: 1316099815
Provider Name (Legal Business Name): ALLAN C MERIT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N 22ND ST
BLAIR NE
68008-1128
US

IV. Provider business mailing address

123 E BARONAGE DR
BLAIR NE
68008-1201
US

V. Phone/Fax

Practice location:
  • Phone: 402-426-2182
  • Fax:
Mailing address:
  • Phone: 402-426-5787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100081
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: