Provider Demographics
NPI:1497847065
Name:MERRILL, VIRGINIA M (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:M
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CEDAR ST
Mailing Address - Street 2:COMMUNITY HEALTH AND COUNSELING SERVICES
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6433
Mailing Address - Country:US
Mailing Address - Phone:207-947-0366
Mailing Address - Fax:
Practice Address - Street 1:42 CEDAR ST
Practice Address - Street 2:COMMUNITY HEALTH AND COUNSELING SERVICES
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6433
Practice Address - Country:US
Practice Address - Phone:207-947-0366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER029770363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NS8062Medicare ID - Type Unspecified
P52243Medicare UPIN