Provider Demographics
NPI:1457947236
Name:MERRIAM, ELIDA OPITZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIDA
Middle Name:OPITZ
Last Name:MERRIAM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELIDA
Other - Middle Name:ADDIS
Other - Last Name:OPITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:439 RUDASILL MILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22749-1813
Mailing Address - Country:US
Mailing Address - Phone:540-533-3907
Mailing Address - Fax:
Practice Address - Street 1:75 W LEE HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2149
Practice Address - Country:US
Practice Address - Phone:540-351-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily