Provider Demographics
NPI:1578535878
Name:MERRITT, EDNA (FNP)
Entity Type:Individual
Prefix:MS
First Name:EDNA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3253
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:BRODY OUTPATIENT CENTER
Practice Address - Street 2:600 MOYE BLVD
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858
Practice Address - Country:US
Practice Address - Phone:252-744-2350
Practice Address - Fax:252-744-3098
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200381363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000447Medicare ID - Type Unspecified
NCS59412Medicare UPIN
NC2596990BMedicare ID - Type Unspecified