Provider Demographics
NPI: | 1760401483 |
---|---|
Name: | MERCER, ALVIN ELMO (NP) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | ALVIN |
Middle Name: | ELMO |
Last Name: | MERCER |
Suffix: | |
Gender: | M |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 202 E EARLL DR STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85012-2647 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-808-2800 |
Mailing Address - Fax: | 602-599-2766 |
Practice Address - Street 1: | 2715 N 3RD ST |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85004-1106 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-264-4331 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-19 |
Last Update Date: | 2019-01-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | AP6256 | 363LP0808X |
AZ | AP0069 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AZ | RN106826 | Other | RN LICENSE |
AZ | AP6256 | Other | NP |