Provider Demographics
NPI:1417392309
Name:MERRILL, KRISTEN (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 STATE ROUTE 122 S
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-8423
Mailing Address - Country:US
Mailing Address - Phone:937-684-0204
Mailing Address - Fax:
Practice Address - Street 1:5006 STATE ROUTE 122 S
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-8423
Practice Address - Country:US
Practice Address - Phone:937-684-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN134925164W00000X
IN27067736A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse