Provider Demographics
NPI:1508075979
Name:MERRIOUNS, ROBERT E
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:MERRIOUNS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 NELCHINA ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-5535
Mailing Address - Country:US
Mailing Address - Phone:907-244-4416
Mailing Address - Fax:907-277-5821
Practice Address - Street 1:1407 NELCHINA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5535
Practice Address - Country:US
Practice Address - Phone:907-244-4416
Practice Address - Fax:907-277-5821
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHC3555372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC3555Medicaid