MEDICARE: DENISHA MERRIWEATHER

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
1	164W00000X	Licensed Practical Nurse	286531-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255566212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISHA MERRIWEATHER

Provider Business Mailing Address
First Line	:	119 CONGRESS ST
Second Line	:	REAR HOUSE
City	:	BUFFALO
State	:	NY
Zip	:	14213-1417
Country	:	US
Telephone Number	:	716-605-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 CONGRESS ST
Second Line	:	REAR HOUSE
City	:	BUFFALO
State	:	NY
Zip	:	14213-1417
Country	:	US
Telephone Number	:	716-605-8518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	05/20/2009

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Directions to “ DENISHA MERRIWEATHER ” Practice Location

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