Provider Demographics
NPI:1093930604
Name:MERRILL, DONNA ZELLA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:ZELLA
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 TRAILWOOD CIR E
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-6825
Mailing Address - Country:US
Mailing Address - Phone:989-832-0857
Mailing Address - Fax:989-667-9661
Practice Address - Street 1:4615 EASTMAN AVENUE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-6825
Practice Address - Country:US
Practice Address - Phone:989-631-7110
Practice Address - Fax:989-892-7455
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIZ96017097OtherMEDICARE PTAN
MIMERRI-0008OtherCOMP CARE
MI2L36020OtherHEALTH PLUS
MIP43930009OtherMEDICARE PTAN
MIE66019086OtherMEDICARE PTAN
MI0Z96017Medicare PIN
MI0P43930Medicare PIN
MI0E66019Medicare PIN
MI2L36020OtherHEALTH PLUS