Provider Demographics
NPI:1164860276
Name:MERRELL, WINIFERD (CNA)
Entity Type:Individual
Prefix:
First Name:WINIFERD
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:GA
Mailing Address - Zip Code:31092-0431
Mailing Address - Country:US
Mailing Address - Phone:478-244-6281
Mailing Address - Fax:
Practice Address - Street 1:522 HARDEN ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:GA
Practice Address - Zip Code:31092-1072
Practice Address - Country:US
Practice Address - Phone:478-244-6281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000026807163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health