Provider Demographics
NPI:1619261328
Name:MERRITT, ALECIA (LPN)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 BRANDYBUCK RD
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9547
Mailing Address - Country:US
Mailing Address - Phone:585-857-0058
Mailing Address - Fax:
Practice Address - Street 1:5372 BRANDYBUCK RD
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9547
Practice Address - Country:US
Practice Address - Phone:585-857-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296993164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse