Provider Demographics
NPI:1558673616
Name:BASHIR, MERCY M (DNP)
Entity Type:Individual
Prefix:
First Name:MERCY
Middle Name:M
Last Name:BASHIR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 ESSEX CENTER DR STE 309
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2907
Mailing Address - Country:US
Mailing Address - Phone:978-837-2410
Mailing Address - Fax:
Practice Address - Street 1:3 MAGNOLIA WAY
Practice Address - Street 2:#3312
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-3871
Practice Address - Country:US
Practice Address - Phone:978-837-2410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN282407363LA2200X, 363LG0600X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology