MEDICARE: LISA MAY MERCIER MSN, AGAC-BC

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	363LA2200X	Adult Health Nurse Practitioner	4704303127	MI
2	363LG0600X	Gerontology Nurse Practitioner	4704303127	MI
3	363LA2100X	Acute Care Nurse Practitioner	4704303127	MI

General Provider Information

NPI Number	:	1699271775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MAY MERCIER MSN, AGAC-BC

Provider Business Mailing Address
First Line	:	2313 WOODLAND AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3878
Country	:	US
Telephone Number	:	248-703-0095
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 WOODLAND AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-3878
Country	:	US
Telephone Number	:	248-703-0095
Fax Number	:

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

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	10/11/2018

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