Provider Demographics
NPI:1700026374
Name:MERCADO, EDITA B (NP)
Entity Type:Individual
Prefix:MRS
First Name:EDITA
Middle Name:B
Last Name:MERCADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1224 GRAHAM RD
Mailing Address - Street 2:1113
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8028
Mailing Address - Country:US
Mailing Address - Phone:314-839-4500
Mailing Address - Fax:314-839-8521
Practice Address - Street 1:1224 GRAHAM RD
Practice Address - Street 2:1113
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8028
Practice Address - Country:US
Practice Address - Phone:314-839-4500
Practice Address - Fax:314-839-8521
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO088761363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology