Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN2277526 | MA |
NPI | 1033572094 |
---|---|
Provider Name | Kimloan Merchant |
First Address | Millersville, MD 21108-1547 |
Second Address | Millersville, MD 21108-1547 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 22/06/2016 |