MEDICARE: ELBA M MERA RN

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	163W00000X	Registered Nurse	585899	NY

General Provider Information

NPI Number	:	1790027282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELBA M MERA RN

Provider Business Mailing Address
First Line	:	8708 AVON ST
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-3131
Country	:	US
Telephone Number	:	718-459-3637
Fax Number	:	718-830-3566

Provider Business Practice Location Address
First Line	:	6817 AUSTIN ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4237
Country	:	US
Telephone Number	:	718-459-3637
Fax Number	:	718-830-3566

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

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/22/2013

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