Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10209428 | OR |
NPI | 1174133664 |
---|---|
Provider Name | Alysa Kristine Merritt |
First Address | Aumsville, OR 97325-9601 |
Second Address | Aumsville, OR 97325-9601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2020 |
Last Update Date | 09/08/2020 |