Provider Demographics
NPI:1376250324
Name:MERRILL, KRISTINA ASHLEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:ASHLEY
Last Name:MERRILL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 N QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-3209
Mailing Address - Country:US
Mailing Address - Phone:516-659-6018
Mailing Address - Fax:
Practice Address - Street 1:115 BROADHOLLOW RD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4992
Practice Address - Country:US
Practice Address - Phone:631-385-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837902163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse