Healthcare Provider Details

I. General information

NPI: 1447436852
Provider Name (Legal Business Name): MARGARET ROSE MERSEREAU RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 DANA CT
CLARENCE CENTER NY
14032-9335
US

IV. Provider business mailing address

9425 DANA CT
CLARENCE CENTER NY
14032-9335
US

V. Phone/Fax

Practice location:
  • Phone: 716-601-5891
  • Fax:
Mailing address:
  • Phone: 716-601-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number309910-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: