Provider Demographics
NPI:1003178203
Name:MERRILL, RHODORA L (BSN)
Entity Type:Individual
Prefix:
First Name:RHODORA
Middle Name:L
Last Name:MERRILL
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1869 SAINT JEAN ST
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4505
Mailing Address - Country:US
Mailing Address - Phone:319-964-2699
Mailing Address - Fax:318-964-2736
Practice Address - Street 1:1869 SAINT JEAN ST
Practice Address - Street 2:
Practice Address - City:MANSURA
Practice Address - State:LA
Practice Address - Zip Code:71350-4505
Practice Address - Country:US
Practice Address - Phone:318-964-2699
Practice Address - Fax:318-964-2736
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN090783163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health