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General NPI Number Information
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NPI Number | 1487280939
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Entity Type | Individual
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Provider Name | RUBI BALTAZAR MERINO
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Gender | Female
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 2231 NASH ST NW
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City | WILSON
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State | NC
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Zip | 27896-1712
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Country | US
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Telephone | 252-320-0544
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Fax |
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Provider Business Mailing Address
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Address Line | 2146 SIR HUGH CT
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City | GREENVILLE
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State | NC
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Zip | 27858-8524
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Country | US
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Telephone | 252-320-0544
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5013099
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 204783
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License Number State | NC
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