Provider Demographics
NPI:1093141095
Name:CHISHOLM, MERCEDEZ MONIQUE (LPN)
Entity Type:Individual
Prefix:MS
First Name:MERCEDEZ
Middle Name:MONIQUE
Last Name:CHISHOLM
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 1:34464 ASPEN RUN
Mailing Address - Street 2:#7
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-2998
Mailing Address - Country:US
Mailing Address - Phone:440-381-6625
Mailing Address - Fax:
Practice Address - Street 1:34464 ASPEN RUN
Practice Address - Street 2:#7
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-2998
Practice Address - Country:US
Practice Address - Phone:440-381-6625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse