Provider Demographics
NPI:1154495356
Name:MERCER, MINNIE A (PA-C)
Entity Type:Individual
Prefix:
First Name:MINNIE
Middle Name:A
Last Name:MERCER
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 1:1355 RAMAR RD STE 11
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7100
Mailing Address - Country:US
Mailing Address - Phone:928-704-9202
Mailing Address - Fax:928-704-9207
Practice Address - Street 1:1355 RAMAR RD STE 11
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7100
Practice Address - Country:US
Practice Address - Phone:928-704-9202
Practice Address - Fax:928-704-9207
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical