Provider Demographics
NPI:1346581816
Name:MERRILL, MADELINE BRADLEY (BSN, RN, MSN, ANP)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:BRADLEY
Last Name:MERRILL
Suffix:
Gender:F
Credentials:BSN, RN, MSN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 92ND ST APT 6L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7437
Mailing Address - Country:US
Mailing Address - Phone:817-917-6241
Mailing Address - Fax:
Practice Address - Street 1:17 E 102ND ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5204
Practice Address - Country:US
Practice Address - Phone:212-214-7863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657486-1163WX0200X, 163W00000X
NYF306785-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology
No163W00000XNursing Service ProvidersRegistered Nurse