Individual
LEECILLE M MERTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1240 PLACE ST, BAKER CITY, OR 97814-4040
(541) 519-6647
Mailing address
516 E 1ST ST, ABERDEEN, WA 98520-4106
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
61097501LPN
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568477297
TREATMENT CENTER
—
Enumeration date
12/05/2020
Last updated
12/05/2020
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