Provider Demographics
NPI:1821452442
Name:DALY, MERRILY DIVINE (LM, CPM, RN)
Entity Type:Individual
Prefix:
First Name:MERRILY
Middle Name:DIVINE
Last Name:DALY
Suffix:
Gender:F
Credentials:LM, CPM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MOKUAHI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8963
Mailing Address - Country:US
Mailing Address - Phone:808-280-2077
Mailing Address - Fax:808-442-1454
Practice Address - Street 1:115 E LIPOA ST STE 103
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8182
Practice Address - Country:US
Practice Address - Phone:808-280-2977
Practice Address - Fax:808-442-1454
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2022-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21789163WM0102X, 163WN0003X, 163WP1700X
TN00040004176B00000X
HI5176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
No163WP1700XNursing Service ProvidersRegistered NursePerinatal