Provider Demographics
NPI:1144832874
Name:MERRILL, LORRAINE K
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:K
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-0806
Mailing Address - Country:US
Mailing Address - Phone:928-243-2383
Mailing Address - Fax:
Practice Address - Street 1:535 N WILMOT RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2683
Practice Address - Country:US
Practice Address - Phone:520-694-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN128057163WP0200X
AZRNP304009363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics