Provider Demographics
NPI:1588326011
Name:MCILMOYL, BIZ MERRY
Entity type:Individual
Prefix:
First Name:BIZ
Middle Name:MERRY
Last Name:MCILMOYL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546B OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1828
Mailing Address - Country:US
Mailing Address - Phone:707-688-5732
Mailing Address - Fax:
Practice Address - Street 1:1546B OAK AVE
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-1828
Practice Address - Country:US
Practice Address - Phone:707-688-5732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018758363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care