Provider Demographics
NPI:1780670117
Name:FOUGERE, MERRY ARMSTRONG (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MERRY
Middle Name:ARMSTRONG
Last Name:FOUGERE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MERRY
Other - Middle Name:
Other - Last Name:ONUFRIEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:621 W MALLON AVE
Mailing Address - Street 2:503
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2163
Mailing Address - Country:US
Mailing Address - Phone:509-455-5546
Mailing Address - Fax:509-455-5201
Practice Address - Street 1:621 W MALLON AVE
Practice Address - Street 2:503
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2163
Practice Address - Country:US
Practice Address - Phone:509-455-5546
Practice Address - Fax:509-455-5201
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004456363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9623455Medicaid
WAPO4220Medicare UPIN
WAAB17731Medicare ID - Type Unspecified