Provider Demographics
NPI:1528595451
Name:PRAKASH, MERCY (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:
Last Name:PRAKASH
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43116 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-2359
Mailing Address - Country:US
Mailing Address - Phone:586-214-7566
Mailing Address - Fax:
Practice Address - Street 1:3120 CARPENTER ST. STE 201
Practice Address - Street 2:ADULT & PEDIATRIC MEDICINE PLLC
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212
Practice Address - Country:US
Practice Address - Phone:313-369-1001
Practice Address - Fax:313-369-1002
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF04170112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily