Organization
AUTUMN D MERCER AGNP-C LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUTUMN DAWN MERCER (PROVIDER)
(503) 309-8026
Entity
Organization
Contact information
Practice address
620 N 5TH ST, JACKSONVILLE, OR 97530-9659
(503) 309-8026
(541) 291-9819
Mailing address
620 N 5TH ST, JACKSONVILLE, OR 97530-9659
(503) 309-8026
(541) 291-9819
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500733407
—
OR
Enumeration date
02/12/2019
Last updated
10/24/2023
Update your record
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