Provider Demographics
NPI:1568915098
Name:MERCURIO, ELAINA (STNA)
Entity Type:Individual
Prefix:MRS
First Name:ELAINA
Middle Name:
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 S UNION ST
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-3218
Mailing Address - Country:US
Mailing Address - Phone:270-881-8800
Mailing Address - Fax:
Practice Address - Street 1:633 S UNION ST
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-3218
Practice Address - Country:US
Practice Address - Phone:270-881-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 372600000X
OH324273750716376K00000X
TN00177146376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
No372600000XNursing Service Related ProvidersAdult Companion