Provider Demographics
NPI:1033831748
Name:MERRELL, GEORGE JUSTIN (APRN-RNP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:JUSTIN
Last Name:MERRELL
Suffix:
Gender:M
Credentials:APRN-RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3891
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503-3894
Mailing Address - Country:US
Mailing Address - Phone:573-757-5700
Mailing Address - Fax:
Practice Address - Street 1:CL-2062.3 SPIDERWOMAN RD
Practice Address - Street 2:
Practice Address - City:CHINLE
Practice Address - State:AZ
Practice Address - Zip Code:86503-3894
Practice Address - Country:US
Practice Address - Phone:573-757-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274695163WC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine