Provider Demographics
NPI:1962863191
Name:PETIT, MERLINE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:MERLINE
Middle Name:
Last Name:PETIT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47878 HWY 58
Mailing Address - Street 2:UNIT # 17
Mailing Address - City:OAKRIDGE
Mailing Address - State:OR
Mailing Address - Zip Code:97463
Mailing Address - Country:US
Mailing Address - Phone:561-633-5360
Mailing Address - Fax:
Practice Address - Street 1:47878 HIGHWAY 58
Practice Address - Street 2:UNIT # 17
Practice Address - City:OAKRIDGE
Practice Address - State:OR
Practice Address - Zip Code:97463-9572
Practice Address - Country:US
Practice Address - Phone:561-633-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201405586LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse