Healthcare Provider Details

I. General information

NPI: 1407087273
Provider Name (Legal Business Name): CAROLE A MERCKLE DTR, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOSPITAL DR CASTROP CENTER
ATHENS OH
45701-2857
US

IV. Provider business mailing address

75 HOSPITAL DR CASTROP CENTER
ATHENS OH
45701-2857
US

V. Phone/Fax

Practice location:
  • Phone: 740-566-4870
  • Fax: 740-566-4871
Mailing address:
  • Phone: 740-566-4870
  • Fax: 740-566-4871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN336250
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number812016
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: