Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 106451 | OK |
NPI | 1003228149 |
---|---|
Provider Name | Michelle Kathleen Merrell |
First Address | Edmond, OK 73012-3489 |
Second Address | Edmond, OK 73012-3489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2014 |
Last Update Date | 23/05/2014 |