Provider Demographics
NPI:1710038146
Name:MERRIFIELD, JOAN ANASTASIA (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ANASTASIA
Last Name:MERRIFIELD
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 1:703 E OVERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-3415
Mailing Address - Country:US
Mailing Address - Phone:580-765-3221
Mailing Address - Fax:
Practice Address - Street 1:13 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4808
Practice Address - Country:US
Practice Address - Phone:580-765-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKROO60491163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse