Healthcare Provider Details

I. General information

NPI: 1356625669
Provider Name (Legal Business Name): JANE ELIZABETH MERK CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

635 W COUNTY LINE RD
HATBORO PA
19040-1302
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7405
  • Fax:
Mailing address:
  • Phone: 215-672-9738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberSP011579
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: