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General NPI Number Information
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NPI Number | 1790241065
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Entity Type | Organization
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Legal Business Name | AUTUMN D MERCER AGNP-C LLC
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Dates
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Enumeration Date | 02/12/2019
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 620 N 5TH ST
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9659
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Country | US
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Telephone | 503-309-8026
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Fax | 541-291-9819
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Provider Business Mailing Address
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Address Line | 620 N 5TH ST
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9659
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Country | US
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Telephone | 503-309-8026
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Fax | 541-291-9819
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Authorized Official
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Title or Position | PROVIDER
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Name | AUTUMN DAWN MERCER
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Credential |
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Telephone | 503-309-8026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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