Provider Demographics
NPI:1821452442
Name:DALY, MERRILY DIVINE (RN, LM, CPM)
Entity type:Individual
Prefix:
First Name:MERRILY
Middle Name:DIVINE
Last Name:DALY
Suffix:
Gender:F
Credentials:RN, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MOKUAHI ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8963
Mailing Address - Country:US
Mailing Address - Phone:808-280-2077
Mailing Address - Fax:808-442-1454
Practice Address - Street 1:165 MOKUAHI ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8963
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI21789163WH0200X, 163WC0400X
TN00040004176B00000X
HI5176B00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management