Provider Demographics
NPI:1982096426
Name:MERLO, ELIZABETH (BA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:MERLO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:COTTRELLVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3205
Mailing Address - Country:US
Mailing Address - Phone:810-580-9289
Mailing Address - Fax:
Practice Address - Street 1:7725 MARSH RD
Practice Address - Street 2:
Practice Address - City:COTTRELLVILLE
Practice Address - State:MI
Practice Address - Zip Code:48039-3205
Practice Address - Country:US
Practice Address - Phone:810-580-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other