Provider Demographics
NPI:1114131745
Name:MERRILL, MARY CATHRINE (CNA HHA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHRINE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:CNA HHA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHRINE
Other - Last Name:RITENBAUGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA HHA
Mailing Address - Street 1:2478 GREENSPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1215
Mailing Address - Country:US
Mailing Address - Phone:513-851-3934
Mailing Address - Fax:513-851-3934
Practice Address - Street 1:2478 GREENSPRINGS CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1215
Practice Address - Country:US
Practice Address - Phone:513-851-3934
Practice Address - Fax:513-851-3934
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2095432Medicaid