Provider Demographics
NPI:1831532605
Name:MERL, KELSEY (C-PNP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MERL
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 MARIPOSA STREET, SUITE 100
Mailing Address - Street 2:TRAUMA RECOVERY/RAPE TREATMENT CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:360-319-1010
Mailing Address - Fax:
Practice Address - Street 1:2727 MARIPOSA STREET, SUITE 100
Practice Address - Street 2:TRAUMA RECOVERY/RAPE TREATMENT CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:360-319-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22891363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics