Provider Demographics
NPI:1528732120
Name:MERKWAN, JERICA LEE (NP-C)
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:LEE
Last Name:MERKWAN
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 1:4025 S PISIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-7670
Mailing Address - Country:US
Mailing Address - Phone:605-310-8114
Mailing Address - Fax:
Practice Address - Street 1:3600 W 43RD ST STE 2
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-6330
Practice Address - Country:US
Practice Address - Phone:605-310-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002126363LF0000X
SDF06212548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily