Individual
ADRIENNE L MERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2222 PHILADELPHIA DR, DAYTON, OH 45406-1813
(937) 734-2612
(937) 567-4163
Mailing address
PO BOX 640446, CINCINNATI, OH 45264-0446
(717) 263-5562
(717) 263-1566
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28174773A
IN
367500000X
Certified Registered Nurse Anesthetist
CERT 92108
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
RN378232
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001027762
ANTHEM PROVIDER NUMBER
IN
05
—
0080856
—
OH
05
—
201368570
—
IN
Enumeration date
11/26/2012
Last updated
01/05/2017
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