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General NPI Number Information
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NPI Number | 1245545235
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Entity Type | Individual
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Provider Name | NICOLE LYNN MERRITT D.O.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 06/29/2025
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Provider Practice Location Address
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Address Line | 5219 LANKFORD HWY
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City | NEW CHURCH
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State | VA
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Zip | 23415-3332
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Country | US
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Telephone | 757-824-5676
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Fax | 757-824-5872
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Provider Business Mailing Address
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Address Line | 5219 LANKFORD HWY
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City | NEW CHURCH
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State | VA
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Zip | 23415-3332
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Country | US
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Telephone | 757-824-5676
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Fax | 757-824-5872
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0102209302
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | H0077515
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OT013788
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License Number State | PA
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