Provider Demographics
NPI:1710353842
Name:MERCADO, CHARMAINE MARY (NP)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:MARY
Last Name:MERCADO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:308 S CESAR CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-4200
Mailing Address - Country:US
Mailing Address - Phone:317-266-2901
Mailing Address - Fax:
Practice Address - Street 1:308 S CESAR CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-4200
Practice Address - Country:US
Practice Address - Phone:830-374-2301
Practice Address - Fax:830-374-9368
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-07-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71007931A363LP0200X
TXAP128590363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics