Provider Demographics
NPI:1851273999
Name:MERCER, EMILY LAURA
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LAURA
Last Name:MERCER
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 1:1805 SE MADISON ST APT 103
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4590
Mailing Address - Country:US
Mailing Address - Phone:541-740-7973
Mailing Address - Fax:
Practice Address - Street 1:1428 SE 19TH AVE STE D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-4516
Practice Address - Country:US
Practice Address - Phone:541-740-7973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-TA-10191261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist