Provider Demographics
NPI:1255382446
Name:MERKLE, DIANE (APRN)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:
Last Name:MERKLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HARBORVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6540
Mailing Address - Country:US
Mailing Address - Phone:203-878-5969
Mailing Address - Fax:
Practice Address - Street 1:33 HARBORVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-6540
Practice Address - Country:US
Practice Address - Phone:203-878-5969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002936363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ08225Medicare UPIN