Provider Demographics
NPI:1952949364
Name:ELISON, MERITA (NP)
Entity Type:Individual
Prefix:
First Name:MERITA
Middle Name:
Last Name:ELISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7856 DALEN ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-4116
Mailing Address - Country:US
Mailing Address - Phone:562-441-5063
Mailing Address - Fax:
Practice Address - Street 1:9100 WILSHIRE BLVD STE 280E
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3562
Practice Address - Country:US
Practice Address - Phone:310-652-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95012742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner