Provider Demographics
NPI:1083162317
Name:MERCER, JANIS
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:MERCER
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 1:3708 S DOUGLAS AVE APT 57
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3250
Mailing Address - Country:US
Mailing Address - Phone:405-662-3313
Mailing Address - Fax:
Practice Address - Street 1:3708 S DOUGLAS AVE APT 57
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3250
Practice Address - Country:US
Practice Address - Phone:405-662-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator