Provider Demographics
NPI:1508285826
Name:MERRILL, MARK EMERSON (RN)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EMERSON
Last Name:MERRILL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9021 E AMHERST DR
Mailing Address - Street 2:UNIT B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4083
Mailing Address - Country:US
Mailing Address - Phone:720-394-5677
Mailing Address - Fax:
Practice Address - Street 1:2550 S PARKER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1622
Practice Address - Country:US
Practice Address - Phone:303-636-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN0112525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse