Provider Demographics
NPI:1881142685
Name:MERRILL, MICHEAL
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:
Last Name:MERRILL
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 1:588 N RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274-6937
Mailing Address - Country:US
Mailing Address - Phone:207-890-1210
Mailing Address - Fax:
Practice Address - Street 1:588 N RAYMOND RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274-6937
Practice Address - Country:US
Practice Address - Phone:207-890-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME374U00000X374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide