Provider Demographics
NPI:1407364474
Name:MERCEDAT, ESTHER
Entity Type:Individual
Prefix:MRS
First Name:ESTHER
Middle Name:
Last Name:MERCEDAT
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 1:114 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3016
Mailing Address - Country:US
Mailing Address - Phone:617-331-1573
Mailing Address - Fax:
Practice Address - Street 1:840 EMERSON GARDENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2615
Practice Address - Country:US
Practice Address - Phone:781-861-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN85358164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse