Provider Demographics
NPI:1043993728
Name:MERCADO, STEPHANY ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:STEPHANY
Middle Name:ANNETTE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MAIN ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1311
Mailing Address - Country:US
Mailing Address - Phone:973-641-8571
Mailing Address - Fax:
Practice Address - Street 1:123 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3694
Practice Address - Country:US
Practice Address - Phone:201-488-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP49464000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse