Provider Demographics
NPI:1942505938
Name:MERRIWETHER, TAMIKA CELITA (REGISTERED NURSE MSN)
Entity Type:Individual
Prefix:MS
First Name:TAMIKA
Middle Name:CELITA
Last Name:MERRIWETHER
Suffix:
Gender:F
Credentials:REGISTERED NURSE MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1819
Mailing Address - Country:US
Mailing Address - Phone:909-388-0810
Mailing Address - Fax:
Practice Address - Street 1:820 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1819
Practice Address - Country:US
Practice Address - Phone:909-388-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531192163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health