Provider Demographics
NPI:1124806021
Name:MERRIAM, CARRI LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:CARRI
Middle Name:LYNN
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33702 CALLE CONEJO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-5017
Mailing Address - Country:US
Mailing Address - Phone:949-275-1762
Mailing Address - Fax:
Practice Address - Street 1:31371 RANCHO VIEJO RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1848
Practice Address - Country:US
Practice Address - Phone:949-487-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily