Provider Demographics
NPI:1669745592
Name:MERCEDES, MIKEAL FREEDOM (RNFA)
Entity type:Individual
Prefix:MR
First Name:MIKEAL
Middle Name:FREEDOM
Last Name:MERCEDES
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6148
Mailing Address - Country:US
Mailing Address - Phone:207-632-9706
Mailing Address - Fax:
Practice Address - Street 1:16 MEMORY LN
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6148
Practice Address - Country:US
Practice Address - Phone:207-632-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN46450163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant