Provider Demographics
NPI:1629197660
Name:MERRIETT, EVELYN NADINE (APRN-C)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:NADINE
Last Name:MERRIETT
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Gender:F
Credentials:APRN-C
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Mailing Address - Street 1:8532 W CAPITOL DR STE 201
Mailing Address - Street 2:# 201 PULMEDIX ASTHMA CARE CENTER & PFT LAB.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1850
Mailing Address - Country:US
Mailing Address - Phone:414-393-4002
Mailing Address - Fax:414-393-4014
Practice Address - Street 1:8532 W CAPITOL DR STE 201
Practice Address - Street 2:# 201
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1850
Practice Address - Country:US
Practice Address - Phone:414-393-4002
Practice Address - Fax:414-393-4014
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1594363LF0000X
WI1594 APNP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0339855OtherNURSE PRACTITIONER
WI65810-30OtherREGISTERED NURSE