Healthcare Provider Details

I. General information

NPI: 1528259884
Provider Name (Legal Business Name): SETH ALLEN MERRITT FNP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6035 SE MILWAUKIE AVE
PORTLAND OR
97202-5344
US

IV. Provider business mailing address

6035 SE MILWAUKIE AVE
PORTLAND OR
97202-5344
US

V. Phone/Fax

Practice location:
  • Phone: 971-258-1120
  • Fax: 866-309-2838
Mailing address:
  • Phone: 971-258-1120
  • Fax: 866-309-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850079NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: