Provider Demographics
NPI:1235158932
Name:MERCK, STEPHANIE F (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:F
Last Name:MERCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORPORATE DR
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-1351
Mailing Address - Country:US
Mailing Address - Phone:203-452-2446
Mailing Address - Fax:203-452-2424
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:SUITE 2-1
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-452-2446
Practice Address - Fax:203-452-2424
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001076363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400001076CT01OtherANTHEM BLUE CROSS BLUE SH
CT400001076CT01OtherANTHEM BLUE CROSS BLUE SH