Provider Demographics
NPI:1457023194
Name:BROCKETT, MERLYN GOMEZ (BSN-RN, MS)
Entity Type:Individual
Prefix:MS
First Name:MERLYN
Middle Name:GOMEZ
Last Name:BROCKETT
Suffix:
Gender:F
Credentials:BSN-RN, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:8918 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2246
Mailing Address - Country:US
Mailing Address - Phone:917-817-8273
Mailing Address - Fax:
Practice Address - Street 1:8918 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2246
Practice Address - Country:US
Practice Address - Phone:917-817-8273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY359302-1163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development