Provider Demographics
NPI:1598707432
Name:MERRY, DONNA (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MERRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10881 RTE 11
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-3154
Mailing Address - Country:US
Mailing Address - Phone:315-232-4400
Mailing Address - Fax:315-232-4455
Practice Address - Street 1:10881 RTE 11
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-3154
Practice Address - Country:US
Practice Address - Phone:315-232-4400
Practice Address - Fax:315-232-4455
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P16012Medicare UPIN