Provider Demographics
NPI:1508221409
Name:MERCER, CHAMARA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CHAMARA
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26375 HALSTED RD APT 217
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3772
Mailing Address - Country:US
Mailing Address - Phone:313-610-2807
Mailing Address - Fax:
Practice Address - Street 1:44300 5 MILE RD
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-9504
Practice Address - Country:US
Practice Address - Phone:866-389-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704269330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily