Provider Demographics
NPI:1831139518
Name:MOUNT, MERRILY (ARNP)
Entity Type:Individual
Prefix:
First Name:MERRILY
Middle Name:
Last Name:MOUNT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294843 HWY 101
Mailing Address - Street 2:
Mailing Address - City:QUILCENE
Mailing Address - State:WA
Mailing Address - Zip Code:98376
Mailing Address - Country:US
Mailing Address - Phone:360-765-3111
Mailing Address - Fax:360-765-3811
Practice Address - Street 1:294843 HWY 101
Practice Address - Street 2:
Practice Address - City:QUILCENE
Practice Address - State:WA
Practice Address - Zip Code:98376
Practice Address - Country:US
Practice Address - Phone:360-765-3111
Practice Address - Fax:360-765-3811
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9615204Medicaid
WA9615204Medicaid
WAS16627Medicare UPIN