Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704131145 | MI |
N | 363LC1500X | Nurse Practitioner - Community Health | 4704131145 | MI |
NPI | 1700946654 |
---|---|
Provider Name | Jennifer Hayden Merritt-Hackel |
First Address | Quincy, MA 02169-4787 |
Second Address | Ann Arbor, MI 48109-2700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 18/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4270523 | (05) | MI |
P14056 | (02) | MI |