Provider Demographics
NPI:1386229128
Name:KARBAKER, MERCY
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:KARBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 WESTPORT BEACH WAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8857
Mailing Address - Country:US
Mailing Address - Phone:701-799-2556
Mailing Address - Fax:
Practice Address - Street 1:1208 WESTPORT BEACH WAY UNIT B
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8857
Practice Address - Country:US
Practice Address - Phone:701-799-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant