Provider Demographics
NPI:1407087273
Name:MERCKLE, CAROLE A (DTR, RN)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:A
Last Name:MERCKLE
Suffix:
Gender:F
Credentials:DTR, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HOSPITAL DR
Mailing Address - Street 2:CASTROP CENTER
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2857
Mailing Address - Country:US
Mailing Address - Phone:740-566-4870
Mailing Address - Fax:740-566-4871
Practice Address - Street 1:75 HOSPITAL DR
Practice Address - Street 2:CASTROP CENTER
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2857
Practice Address - Country:US
Practice Address - Phone:740-566-4870
Practice Address - Fax:740-566-4871
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN336250163WD0400X
812016136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered