Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 36003368 | OH |
Y | 222Z00000X | Podiatrist | 36003368 | OH |
NPI | 1033110374 |
---|---|
Provider Name | Dr. Dena S Merriman |
First Address | Medina, OH 44256-4700 |
Second Address | Medina, OH 44256-4700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 11/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00144105 | MEDICARE RAIL ROAD (01) | OH |
V00181 | (02) | OH |