MEDICARE: MYRLENE MERISIER 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
1	363LF0000X	Family Nurse Practitioner	F343831-1	NY

General Provider Information

NPI Number	:	1407518855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRLENE MERISIER FNP

Provider Business Mailing Address
First Line	:	1164 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5418
Country	:	US
Telephone Number	:	718-363-1350
Fax Number	:	718-778-1994

Provider Business Practice Location Address
First Line	:	1164 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5418
Country	:	US
Telephone Number	:	718-363-1350
Fax Number	:

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

Provider Enumeration Date	:	10/12/2021
Last Update Date	:	10/12/2021

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