Provider Demographics
NPI:1619266483
Name:MERMER, TERA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:ANN
Last Name:MERMER
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 1:2170 S BERKEY SOUTHERN RD
Mailing Address - Street 2:LOT 201
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9690
Mailing Address - Country:US
Mailing Address - Phone:567-395-2929
Mailing Address - Fax:
Practice Address - Street 1:2170 S BERKEY SOUTHERN RD
Practice Address - Street 2:LOT 201
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-9690
Practice Address - Country:US
Practice Address - Phone:567-395-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.133091-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse