Individual
MERRILL LEE MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTIONER
Contact information
Practice address
100 ELDEN ST STE 10, HERNDON, VA 20170-4833
(703) 404-4600
(703) 478-6612
Mailing address
PO BOX 603725, CHARLOTTE, NC 28260-3725
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
0001097504
VA
363L00000X
Nurse Practitioner
Primary
0024097504
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1558663112
—
NC
01
—
1V9636
MEDICARE PTAN
VA
Enumeration date
12/02/2010
Last updated
10/31/2023
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