Provider Demographics
NPI:1972536092
Name:O'SULLIVAN, MERITA G (CNM)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:G
Last Name:O'SULLIVAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201088
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-1088
Mailing Address - Country:US
Mailing Address - Phone:713-500-3500
Mailing Address - Fax:
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5600
Practice Address - Fax:713-566-4418
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX559161367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80065MOtherBCBS
TX80065MOtherBCBS
TX80065MMedicare PIN