Provider Demographics
NPI:1053635003
Name:MERA, FANNY JACQUELINE (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:FANNY
Middle Name:JACQUELINE
Last Name:MERA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1318
Mailing Address - Country:US
Mailing Address - Phone:212-227-2294
Mailing Address - Fax:212-227-0355
Practice Address - Street 1:145 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1318
Practice Address - Country:US
Practice Address - Phone:212-227-2294
Practice Address - Fax:212-227-0355
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF420960-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health