Provider Demographics
NPI:1962073288
Name:MERILLAT, KATHY A (RN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:MERILLAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11500 PLEASANT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-9558
Mailing Address - Country:US
Mailing Address - Phone:734-972-4583
Mailing Address - Fax:734-572-1839
Practice Address - Street 1:11500 PLEASANT VIEW DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-9558
Practice Address - Country:US
Practice Address - Phone:734-972-4583
Practice Address - Fax:734-572-1839
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704155128163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management