Provider Demographics
NPI:1679267793
Name:MERCADO, LUZ V (LPN)
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:V
Last Name:MERCADO
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 1:904 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01505-1735
Mailing Address - Country:US
Mailing Address - Phone:774-364-3497
Mailing Address - Fax:
Practice Address - Street 1:904 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01505-1735
Practice Address - Country:US
Practice Address - Phone:774-364-3497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN99854164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse