Individual
MR. GARY JOHN CLINTON MERSEREAU SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSN, RN
Contact information
Practice address
914 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 330-8785
Mailing address
815 WAYNE DR, CENTRALIA, WA 98531-9024
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
RN60383846
WA
Other
Enumeration date
06/16/2020
Last updated
06/16/2020
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