Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0127X | Trauma Surgeon | STUDENT | AZ |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN182924 | AZ |
NPI | 1336784735 |
---|---|
Provider Name | Mrs. Amber Rose Merrill |
First Address | Marana, AZ 85658-1420 |
Second Address | Tucson, AZ 85719-4330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2019 |
Last Update Date | 09/02/2022 |