Provider Demographics
NPI:1700185931
Name:MERRICK, MARY J (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:J
Last Name:MERRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:80 SAWGRASS CV
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:TN
Mailing Address - Zip Code:38060-5335
Mailing Address - Country:US
Mailing Address - Phone:901-821-5841
Mailing Address - Fax:901-821-5662
Practice Address - Street 1:80 SAWGRASS CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:TN
Practice Address - Zip Code:38060-5335
Practice Address - Country:US
Practice Address - Phone:901-821-5841
Practice Address - Fax:901-821-5662
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse