Provider Demographics
NPI:1982988515
Name:MERRILL, CHARLOTTE G (APRN, DNP, FNP-C,)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:G
Last Name:MERRILL
Suffix:
Gender:F
Credentials:APRN, DNP, FNP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WOODWORTH
Mailing Address - State:LA
Mailing Address - Zip Code:71485-9511
Mailing Address - Country:US
Mailing Address - Phone:318-704-6568
Mailing Address - Fax:318-704-6572
Practice Address - Street 1:2809 DONAHUE FERRY RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4513
Practice Address - Country:US
Practice Address - Phone:318-704-6568
Practice Address - Fax:318-704-6572
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily