Provider Demographics
NPI:1710487376
Name:MERK, MA CORAZON OMBAO (LVN)
Entity Type:Individual
Prefix:
First Name:MA CORAZON
Middle Name:OMBAO
Last Name:MERK
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:OMBAO
Other - Last Name:MERK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:612 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:612 LAURA LN
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2811
Practice Address - Country:US
Practice Address - Phone:972-841-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331666164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse