Healthcare Provider Details

I. General information

NPI: 1477480978
Provider Name (Legal Business Name): NICHOLAS MERVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 HILLSIDE LN
FALLSINGTON PA
19054-1133
US

IV. Provider business mailing address

2951 POPLAR ST
PHILADELPHIA PA
19130-1129
US

V. Phone/Fax

Practice location:
  • Phone: 267-774-2670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP034955
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: