Provider Demographics
NPI:1801570585
Name:MERCIECA, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MERCIECA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 JOLLY RD STE 3
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-9825
Mailing Address - Country:US
Mailing Address - Phone:517-709-2240
Mailing Address - Fax:
Practice Address - Street 1:2175 JOLLY RD STE 3
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-9825
Practice Address - Country:US
Practice Address - Phone:517-709-2240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
MI1770087587374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health