Provider Demographics
NPI:1639518145
Name:MERCIEZ, JENNIFER GAIL (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GAIL
Last Name:MERCIEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 MASON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2421
Mailing Address - Country:US
Mailing Address - Phone:810-424-4674
Mailing Address - Fax:810-257-1347
Practice Address - Street 1:725 MASON ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2421
Practice Address - Country:US
Practice Address - Phone:810-424-4674
Practice Address - Fax:810-257-1347
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704191347163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health