Provider Demographics
NPI:1841274586
Name:MERRICK, PATRICIA S (CNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:MERRICK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055
Mailing Address - Country:US
Mailing Address - Phone:220-564-7750
Mailing Address - Fax:220-564-7751
Practice Address - Street 1:1320 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055
Practice Address - Country:US
Practice Address - Phone:220-564-7750
Practice Address - Fax:220-564-7751
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN180399163W00000X
OHNP04716363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472275Medicaid
S79029Medicare UPIN
OH2472275Medicaid