Healthcare Provider Details

I. General information

NPI: 1932038601
Provider Name (Legal Business Name): NICOLE T MERENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 SPRUCE ST
PHILADELPHIA PA
19107-6130
US

IV. Provider business mailing address

246 E EVERGREEN AVE
PHILADELPHIA PA
19118-2823
US

V. Phone/Fax

Practice location:
  • Phone: 215-316-5151
  • Fax:
Mailing address:
  • Phone: 610-568-5931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN701509
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: