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NPI Code Detail

MEDICARE: MARILYN S MERRITT FNP

MEDICARE: MARILYN S MERRITT FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner20050046NPOR

General Provider Information

NPI Number : 1043274434
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN S MERRITT FNP
Provider Business Mailing Address
First Line : PO BOX 888918
Second Line :
City : LOS ANGELES
State : CA
Zip : 90088-8918
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1350 NE 122ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97230-2011
Country : US
Telephone Number : 503-408-7008
Fax Number : 503-408-7045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 01/06/2022

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