Healthcare Provider Details

I. General information

NPI: 1356640288
Provider Name (Legal Business Name): MERCY ETTA EYONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2011
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BLUE MOON DR
COLUMBUS OH
43232-5490
US

IV. Provider business mailing address

2924 BLUE MOON DR
COLUMBUS OH
43232-5490
US

V. Phone/Fax

Practice location:
  • Phone: 614-863-8717
  • Fax:
Mailing address:
  • Phone: 614-589-7895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number447144
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: