Provider Demographics
NPI:1033561527
Name:MERRILL, JENNIE MAY
Entity Type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:MAY
Last Name:MERRILL
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 1:3427 WOODLAND TRL
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-8241
Mailing Address - Country:US
Mailing Address - Phone:269-217-3991
Mailing Address - Fax:
Practice Address - Street 1:3427 WOODLAND TRL
Practice Address - Street 2:
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-8241
Practice Address - Country:US
Practice Address - Phone:269-217-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other