Provider Demographics
NPI:1780254888
Name:PREWETT, MERCYDES L (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MERCYDES
Middle Name:L
Last Name:PREWETT
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:MERCYDES
Other - Middle Name:LEIGH
Other - Last Name:HAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 LATCHAW DR
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-4315
Mailing Address - Country:US
Mailing Address - Phone:419-785-4215
Mailing Address - Fax:
Practice Address - Street 1:210 LATCHAW DR
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-4315
Practice Address - Country:US
Practice Address - Phone:419-785-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028574363L00000X
OH0028574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner