=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871914895
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERLIN ARBOR LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2013
-----------------------------------------------------
Last Update Date | 12/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2526 NE 15TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97212-4222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-288-7668
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2885 SANFORD AVE SW #17521
-----------------------------------------------------
City | GRANDVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49418-1342
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-884-1702
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 19648
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------