Healthcare Provider Details

I. General information

NPI: 1285032953
Provider Name (Legal Business Name): CHRISTINE MERRILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOIS LN
GREENWOOD WV
26415-9500
US

IV. Provider business mailing address

2507 9TH AVE
PARKERSBURG WV
26101-5855
US

V. Phone/Fax

Practice location:
  • Phone: 304-873-1808
  • Fax:
Mailing address:
  • Phone: 304-485-6513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number58769
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58769
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: